Peripheral Arterial Disease Flashcards
peripheral arterial disease (PAD)
presence of a stenosis or occlusion n the aorta or arteries of the limbs
what commonly causes PAD?
atherosclerosis in patients over 40
where does PAD most commonly occur?
lower extremities
patients with PAD have an increased risk of …… and ……. events
cardio and cerebrovascular.
where at in the artery are lesions common?
at the branch points
Primary sites of involvement for PAD
- abdominal aorta and iliac arteries
- popliteal and femoral arteries
- tibial and peroneal arteries
why are lesions more common at the arterial branch points?
- increased turbulence
- altered shear stress
- intimal injury
risk factors for PAD
- smoking*
- DM*
- hypercholesterolemia
- hypertension
- renal insufficiency
ACC/AHA recommends patients in the following categories be evaluated for PAD
- over 70 yo
- 50-69 with history of smoking or DM
- 40-49 with DM and at least one other risk factor
- known atherosclerosis at other sites
distal aorta and proximal common iliac disease is mc in …
white, male smokers aged 50-60
femoral-popliteal disease is MC in …
- patients over 60
- black and hispanics
tibial artery disease is MC in …
diabetic and elderly patients
most typical symptom of PAD
intermittent claudication
characteristics of claudication in PAD
characterized by pain, aching, cramping, numbness, or muscle fatigue that occurs during exercise and is relieved by rest
how long does it take for symptoms to subside after exercise cessation?
10 min
pseudoclaudication
painful cramps that are not caused by peripheral artery disease, but can mimic PAD
common causes of pseudoclaudication
- spinal canal stenosis
- herniated disc impingement on sciatic nerve
differences between claudication and pseudoclaudication
- claudication: not associated with standing, lasts shorter amount of time, exercise induced
- pseudoclaudication: occurs with standing, can last up to 30 minutes, not necessarily exercise induced
patients with ….. and ….. artery disease typically do not have claudication
tibial; pedal
……. may be the first sign of vascular insufficiency
rest pain or ulceration.
how is PAD rest pain relieved?
dependency (hanging foot off the edge of the bed)
PAD classification aims to grade …… and ……. responsible for symptoms
symptoms and anatomic lesions
MC tool to assess anatomic lesion classification
Trans-Atlantic Inter-Society Consensus (TASCII)
tool used to classify clinical severity of PAD
wound, ischemia, and foot infection classification (WIFI)
most important PE for PAD
pulse exam
classic PE findings for PAD
- decreased or absent pulses peripheral to obstruction
- cool skin
- cyanotic
- atrophy of muscles
- hair loss
- ulcers
Leg lift test
-elevate leg to 60 degrees for 1 minute
-positive test if pallow occurs
assess for dependent rubor
-evaluate when patient become seated after being supine
-foot will become extremely red
best screening tool for PAD
ankle brachial index
t/f the majority of the time, ABI, history, and PE can allow you to make a PAD diagnosis with no other testing
true
who should be screened for PAD?
- patients with history or PE findings suggestive of PAD
- patient with increased risk of PAD but without H&P findings
interpretation of ABI
- > 1.40: non-compressible vessel
- 1.4-1: normal
- .99-.91: borderline
- .90-.70: diagnostic of PAD
- .69-.40: moderate
- <.40: severe
limitations of ABI
- incompressible arteries
- not good for detecting mild disease
- not designed to define degree of functional limitation
- does not define location of disease
…. is used when the ABI os over 1.4
toe brachial index (TBI)
…. are typically spared from medial arterial disease
digital vessels
TBI< ….. is abnormal and diagnostic of PAD
0.70
treadmill exercise test assesses ……
functional capacity
treadmill exercise test cannot be used if…
- patient has non-compressible vessels
- cannot walk on treadmill
procedure of treadmill exercise test
- resting ABI measured at baseline
- then patient walks on treadmill until they cannot tolerate claudication
- patient resumes supine position and ABI measurements are taken every 1-2 minutes until they reach pre-exercise level
a decrease in ABI of more than …. immediately following exercise if diagnostic of PAD
20 %
segmental limb pressure
multiple cuffs placed on legs to obtain a more specific information
a decrease between two consecutive levels of ….. suggests arterial disease of the artery proximal to the cuff
> 30mmHg
uses of arterial duplex
- determining severity of disease
- confirming PE findings
- useful if intervention is being considered to assess risk/benefit ratio
when should MRA be condisered?
when surgical intervention is considered
magnetic resonance angiography (MRA)
procedure used to examine blood vessels
when should CTA be considered?
when surgical intervention is considered
gold standard for peripheral vascular imaging
digital subtraction angiography