Peripheral Arterial Disease Flashcards
Pathophysiology of lower extremity occlusive disease
Atherosclerosis (smoking, DM)
Embolism (cardiac, aneurysms, atheroemboli)
entrapment, adventitial cystic
Pathophysiology of aneurysmal disease
Atherosclerosis, Dissection, Trauma, Infection
Pathophysiology of carotid bifurcation disease (stroke)
Embolism
hemodynamic
thrombosis
Indications for intervention in lower extremity disease
NOT: presence of symptoms, ankle-arm measurement
ARE: disabling symptoms, limb threat
Clinical presentation of lower extremity occlusive disease
Claudication (cramp, ache, fatigue –> relieve by rest)
Rest pain later in disease (improve by dependency)
Acute Ischemia
Treatment options for lower extremity disease
Risk factor management
Exercise
Anticoagulation
Endovascular:
Balloon angioplasty, stenting, stent-grafting, atherectomy
Open surgical:
endarterectomy, bypass procedures
Where are aneurysms typically located?
Aortic (infrarenal)
Peripheral (popliteal)
Visceral (renal, splenic)
Presentation of Acute Ischemia
6 Ps: Pain Pallor Paresthesia Paralysis Pulselessness Poikilothermia
May be due to thrombosis or embolism
Clinical presentation of carotid bifurcation/stroke
hemispheric symptoms, ocular
rarely global
Clinical presentation of aneurysmal disease
May be asymptomatic!
Rupture
Embolism
Thrombosis
Ankle arm index is
doppler measurement of systolic pressure comparison between lower extremity and upper extremity
Normal > 1
Goes down with occlusion
Diagnosis of carotid bifurcation/stroke
carotid bruit
duplex scanning
MRA, CTA
intra-arterial digital angiography
Imaging for lower extremity disease
angiographic imaging when intervention is planned
Ultrasound is sufficient for diagnostic
Key treatment for Peripheral Vascular Disease
Risk factor modification!
Statin
Exercise
Anti-platelet (aspirin)
Treatment for stroke/carotid bifurcation disease
Risk factor modification!
Anti-platelet therapy
These patients always have coronary disease, as well
Best imaging to detect aneurysms
Ultrasound (least invasive, least expensive)
Also: CT (can determine expansion), arteriography (usually not helpful/necessary)
Indications for intervention of stroke/carotid bifurcation disease
Severity of stenosis
Symptomatic vs asymptomatic patients
Consider life expectancy!
Indications for treatment for aneurysmal disease
Size (larger in men than women, ~5.5)
Surgical Risk
Life expectancy
Intervention options for carotid bifurcation/stroke
Carotid endarterectomy
Carotid Stenting
Treatment options for aneurysmal disease
Open surgical: graft repair, bypass/ligation
Endovascular: stent-grafting
lower morbidity/mortality, lifetime surveillance
Almost all patients with peripheral disease also have ________ disease
Cardiac
Carotid endarterectomy
Carotid stenting
Treatment options for carotid bifurcation disease
Cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries
Claudication
How is duplex scanning interpreted?
color changes indicate higher velocity of flow, can identify stenosis in vessels
What is important on the physical exam of lower extremity disease?
Appearance, Temperature, Pulses, Tissue Loss
Test that is less quantitative but similar to ankle-arm index
Pulse volume recording
Potential cause of pain in lower extremity disease
Neurogenic claudication
