Peripheral Arterial Disease

Question 1

Pathophysiology of lower extremity occlusive disease

Answer 1

Atherosclerosis (smoking, DM)
Embolism (cardiac, aneurysms, atheroemboli)
entrapment, adventitial cystic

Question 2

Pathophysiology of aneurysmal disease

Answer 2

Atherosclerosis, Dissection, Trauma, Infection

Question 3

Pathophysiology of carotid bifurcation disease (stroke)

Answer 3

Embolism
hemodynamic
thrombosis

Question 4

Indications for intervention in lower extremity disease

Answer 4

NOT: presence of symptoms, ankle-arm measurement

ARE: disabling symptoms, limb threat

Question 5

Clinical presentation of lower extremity occlusive disease

Answer 5

Claudication (cramp, ache, fatigue –> relieve by rest)

Rest pain later in disease (improve by dependency)

Acute Ischemia

Question 6

Treatment options for lower extremity disease

Answer 6

Risk factor management
Exercise
Anticoagulation

Endovascular:
Balloon angioplasty, stenting, stent-grafting, atherectomy

Open surgical:
endarterectomy, bypass procedures

Question 7

Where are aneurysms typically located?

Answer 7

Aortic (infrarenal)
Peripheral (popliteal)
Visceral (renal, splenic)

Question 8

Presentation of Acute Ischemia

Answer 8

6 Ps:
Pain
Pallor 
Paresthesia
Paralysis
Pulselessness
Poikilothermia

May be due to thrombosis or embolism

Question 9

Clinical presentation of carotid bifurcation/stroke

Answer 9

hemispheric symptoms, ocular

rarely global

Question 10

Clinical presentation of aneurysmal disease

Answer 10

May be asymptomatic!

Rupture
Embolism
Thrombosis

Question 11

Ankle arm index is

Answer 11

doppler measurement of systolic pressure comparison between lower extremity and upper extremity

Normal > 1
Goes down with occlusion

Question 12

Diagnosis of carotid bifurcation/stroke

Answer 12

carotid bruit
duplex scanning
MRA, CTA
intra-arterial digital angiography

Question 13

Imaging for lower extremity disease

Answer 13

angiographic imaging when intervention is planned

Ultrasound is sufficient for diagnostic

Question 14

Key treatment for Peripheral Vascular Disease

Answer 14

Risk factor modification!

Statin
Exercise
Anti-platelet (aspirin)

Question 15

Treatment for stroke/carotid bifurcation disease

Answer 15

Risk factor modification!
Anti-platelet therapy

These patients always have coronary disease, as well

Question 16

Best imaging to detect aneurysms

Answer 16

Ultrasound (least invasive, least expensive)

Also: CT (can determine expansion), arteriography (usually not helpful/necessary)

Question 17

Indications for intervention of stroke/carotid bifurcation disease

Answer 17

Severity of stenosis
Symptomatic vs asymptomatic patients

Consider life expectancy!

Question 18

Indications for treatment for aneurysmal disease

Answer 18

Size (larger in men than women, ~5.5)
Surgical Risk
Life expectancy

Question 19

Intervention options for carotid bifurcation/stroke

Answer 19

Carotid endarterectomy

Carotid Stenting

Question 20

Treatment options for aneurysmal disease

Answer 20

Open surgical: graft repair, bypass/ligation

Endovascular: stent-grafting
lower morbidity/mortality, lifetime surveillance

Question 21

Almost all patients with peripheral disease also have ________ disease

Answer 21

Cardiac

Question 22

Carotid endarterectomy

Carotid stenting

Answer 22

Treatment options for carotid bifurcation disease

Question 23

Cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries

Answer 23

Claudication

Question 24

How is duplex scanning interpreted?

Answer 24

color changes indicate higher velocity of flow, can identify stenosis in vessels

Question 25

What is important on the physical exam of lower extremity disease?

Answer 25

Appearance, Temperature, Pulses, Tissue Loss

Question 26

Test that is less quantitative but similar to ankle-arm index

Answer 26

Pulse volume recording

Question 27

Potential cause of pain in lower extremity disease

Answer 27

Neurogenic claudication