Peripheral Arterial Disease Flashcards
Two most potent risk factors to develop Peripheral Arterial Disease (PAD).
- Smoking
2. Diabetes
Major co-morbidity of PAD.
Coronary Artery Disease (CAD): about 50% of patients with PAD will develop this
How do asymptomatic patients with PAD present?
No obvious signs of claudication. However, if the patient is forced to exertion then the symptoms might be produced to help with a diagnosis.
How do PAD patients present with classic claudication?
Lower extremity symptoms confined to the muscles with a consistent and reproducible onset with exercise and relief with rest.
How do PAD patients present with Atypical leg pain?
Lower extremity discomfort that is exertional but that does not consistently resolve with rest
How do PAD patients present with Critical Limb Ischemia (CLI)?
Restless leg pain accompanied by non-healing ulcers or gangrene
How do PAD patients present with Acute Limb Ischemia (ALI)?
5 P’s
Pain, pulselessness, pallor, paresthesia, paralysis
Condition commonly associated with ALI.
Atrial Fibrillation: improper emptying of blood from the atria leads to stasis and thrombus formation which can embolize and occlude limb arteries.
Where do symptoms commonly present with occlusion of these vessels:
- Aorto-iliac
- Common Femoral
- Femoral/Popliteal
- Tibial-Peroneal Trunk
- Buttocks/thighs
- thighs
- calves
- feet
Describe the Rutherford Classification PAD.
Stage 0: no symptoms Stage I: minor claudication Stage II: moderate claudication Stage III: severe claudication Stage IV: Resting Pain Stage V: Minor Tissue Loss Stage VI: Major Tissue Damage
What is the scale of pulse classification for patients with PAD?
0 = absent 1 = diminished 2 = normal 3 = bounding
What are some differences between claudication caused by PAD vs. pseudoclaudication caused by something else?
Claudication: short duration (<5min), occurs after walking a certain distance, relieved by standing.
Pseudo: longer duration (30 min), occurs with standing, relieved by positional changes
How is the Ankle-Brachial Index (ABI) calculated?
- Measure both the posterior tibial and dorsalis pedis blood pressures. Use the higher value
- Measure brachial pulses bilaterally and use the higher value.
- Divide the higher ankle bp value by the higher brachial bp value.
What are the classifications for ABI values?
- 0 - 1.29 = normal
- 9 - 0.99 = borderline
- 41 - 0.89 = mild/moderate disease
- 3 is incomprehensible
What are the two limb goals and two cardiovascular goals for treating PAD?
Limb: prevent amputation and improve QOL
CV: prevent stroke and MI
Best treatment to reduce risk of MI, congestive heart failure, chronic renal failure, and death in a patient with PAD.
Reduce BP
When treating PAD with medication and exercise, what is important to remember?
Even if the Tx causes worse claudication or discomfort, it is still necessary because the CV diseases that arise from PAD are what actually cause death.
What are the target BP’s in patients with PAD and no other risk factors vs. someone with diabetes or chronic renal failure?
PAD only: <130/80
Treatment to lower cholesterol in patients with PAD.
Statins
Two drugs used as antiplatelet therapy in patients with PAD. When is antiplatelet therapy indicated?
Aspirin and Clopidogrel
Normally used in asymptomatic PAD
When is endovascular treatment indicated for PAD?
In patients that are disabled due to claudication that are unresponsive to exercise or meds.
When is surgical treatment indicated for PAD?
In patients that are disabled due to claudication that don’t respond to exercise or medication. Also in patients with combined inflow or outflow disease (CLI or ALI).
How are acute and chronic limb ischemia differentiated on PE?
Acute: contralateral limb is usually normal, sudden onset of intense symptoms
Chronic: irregular/weak pulse w/ lesions, ulcers, bilaterally, dull symptoms that gradually developed
What is treatment or ALI?
- Anticoagulant
2. Call vascular specialist and figure out etiology
