peripheral arterial disease Flashcards
Atherosclerosis results in the accumulation of lipid and fibrous material between the layers of the arterial wall ( —) of the coronary, cerebral and peripheral arteries.
Atherosclerotic disease often involves the arteries providing flow to the — extremities – Peripheral Arterial Disease.
Atherosclerosis can lead to acute or chronic symptoms
- classification:
1- occlusive disorder: acute or chronic
2- aneurysmal disorder
3- vasilaitic
suboptimal
lower
- epidemiology and risk factor:
Approx. 10% of adults > — years
Overall burden of PAD greater for — compared to men
Well defined risk factors:
Older age
Smoking
Diabetes
HTN
Hypercholesterolemia
Ethnicity
Family History - clinical presentation:
— and atypical — extremity pain
— pain
> 55
women
claudication
lower
rest
ulceration
gangrene
intermittent claudication:
Derived from the Latin word for limp
Defined as- — discomfort of a defined group group of — that is induced by — and — with rest.
-Atypical lower extremity pain may be — common than claudication due to comorbidities, physical inactivity and alterations in pain perception.
- rest pain : is a — pain of the lower leg or feet. It begins, or is aggravated, after — or — the limb and is relieved by hanging leg – the bed.
reproducible
muscles
excersise
relieved
more common
continuous
reclining or elevating
outside
An ulcer is a —- of the continuity of the skin, epithelium or mucous membrane caused by sloughing out of — , — tissue.
-Arterial ulcers often have the following characteristics:
Punched-out appearance
Intensely painful
Grey or yellow fibrotic base and undermining skin margins
Pulses are not —
Most common on — ends of limbs
Can have associated skin changes- — skin, absence of –
breach
inflammatory necrotic
no palpable
distal ends
shiny skin and absence of hair
Gangrene is a type of tissue – caused by a lack of —
Dry gangrene is a form of — necrosis that develops in — tissue where blood supply is — to keep tissue viable.
The affected part is dry, shrunken and dark reddish-black. This usually brings about — separation, with eventual falling off of the gangrene if not removed surgically- a process known as —
death
blood supply
coagulative
ischemic
complete
autoamputation
factors influencing management decisions:
1- Nature of —
Critical Ischaemia V Non-Critical Ischaemia
Risk to Life or Limb
2-Patient’s General State of –
3- – Circumstances
Independence
Quality of Life
- diagnosis :
History & Examination
Ankle Brachial Index (ABI)
ABI following exercise testing
—- is commonly used in conjunction with the ABI to identify the location and severity of arterial obstruction
Radiology: angiogram
CT angiography
MR Angiogram
(usually reserved for patients where uncertainty remains following noninvasive testing or intervention is anticipated)
- ABI = Peak Doppler Systolic Ankle Pressure
Peak Doppler Systolic Arm Pressure (ankle brachial index )
symptoms
health
social
Duplex ultrasonography
management of PAD:
The management of patients with lower extremity PAD is aimed at relieving — and lowering the risk of — disease — and —.
-The treatment of symptomatic lower is based on a careful assessment of risk factors, medical comorbidities, compliance with pharmacological treatments and follow up care.
-Patients with ischaemic pain or ulceration may require early intervention for –
- risk factor modification:
Exercise
Smoking cessation
Antiplatelet therapy
Lipid-lowering therapy
Treatment of hypertension
Glycaemic control
symptoms
cardiovascular
progression and complication
limb salvage
treatment for symptomatic PAD:
-The initial treatment for exertional limb pain is a supervised — program.
-With intensive medical management (risk factor reduction, exercise therapy, pharmacologic therapy) less than 3% or patients with claudication will develop any signs of limb-threatening – .
- surgical magement:
Endovascular:
-Percutaneous —
- —
—- Vascular Surgery (endarterectomy/bypass)
- —
exercise
ishcemia
angioplasty
stents
reconstructive
amputation
acute limb ishcemia:
Acute Ischaemia
- —
- —
Others e.g —
Symptoms & Signs (“ 6 P’s ”) - —
- —
- —-
- —
-Perishing —
-
–> Urgent Intervention
embolism
thrombosis
trauma
pain
pallo
paulsness
paraethsia
cold
paralysis
ethology:
1-Thrombosis
Atherosclerosis, Bypass graft occlusion, Popliteal aneurysm
2. Embolic:
80% A Fib, 10% MI, 10% Aneurysm
3. Trauma / Iatrogenic
Diff Dx
Chronic Ischemia, Dissection, Vasospastic Disorders, Phlegmesia alba dolens, CHF, Meningococcal septicaemia
acute limb ischemia:
thrombus
Thrombus on a pre-existing — lesion
Patient has history of intermittent —
treatment:
- Based on — / — of ischemia / predicted —
- Resuscitation / Heparinisation
1- Open — – Thromboembolectomy / Bypass
2- —
3- Other — Options
atheroslcotic
claudication
aetiology
severity of ischemia
outcome
surgical
thrombolysis
endovasuclar
embolectomy:
Ensure inflow
Pass Fogarty balloon
Check: Back-bleeding
Completion angio
Doppler
summary:
Chronic PAD – NB determining differential and severity of disease
Management
Medical
Endovascular
Open Surgery
Acute Limb Ischemia – 6Ps
