Peripheral Arterial Disease, DVT, and Chronic Venous Insufficiency Flashcards
what are the most significant risk factors for PAD?
if they have atherosclerosis somewhere else in the body (so if someone has had an ischemic stroke, ACS, MI, or angina), hypertension, hyperlipidemia, DM, CKD, and smoking
what happens to the risk for PAD if a person has one of the risk factors for PAD?
the risk increased 1.5 fold
what happens if a person has 3+ risk factors for PAD?
the risk for PAD increased 10 fold
what is the difference between a plaque rupture and a plaque erosion?
plaque rupture: large lipid core +thin fibrous cap; plaque erosion: scant lipid+ thick fibrous cap
how does the clinical presentation of atherosclerotic disease vary?
could be asymptomatic or symptomatic; symptomatic patients have varying symptoms based on location and based on acuity
how does chronic PAD present?
intermittent claudication: fatigue, discomfort, cramping, pain in muscles of affected limb; induced by exercise and relieved with rest
what should be noted about chronic ischemia seen in PAD?
40% of patients have no leg symptoms and 50% of patients who do have symptoms do not follow the classic pattern
how does acute arterial occlusion seen in PAD present?
medical emergency- LIMB ATTACK; 6 Ps: poikilothermia, pain, pallor, pulselessness, paralysis, paresthesias
how long can skeletal muscle tolerate ischemia for?
~4-6 hours
how do you diagnose/ screen for chronic ischemia seen in PAD?
you start with an ankle-brachial test; if it is higher than a .9 it is ok; if it is lower than a .9 it is bad and they need further testing- a definitive diagnostic procedure
what are 3 examples of definitive diagnostic procedures used to diagnose PAD?
arterial US, CT angiography, and angiography
what is an important step before any revascularization procedure?
an angiography
how do you treat PAD?
meticulous control of those risk factors like DM and HTN; exercise, drug therapy
what are some of the drug therapies used for PAD?
antiplatelet therapy: aspirin or clopidogrel; statin therapy (high intensity); antihypertensive therapy for those with HTN; meds that improve circulatory flow
what are 2 meds that improve circulatory flow?
cilostazol and pentoxifylline
which drug increases red cell deformability/ improves flow; but does not help with symptoms and is actually not recommended?
pentoxifylline
for patients who have an inadequate response to medical therapy or they just have a really significant lifestyle-limiting claudication, what is the treatment of choice?
revascularization
what are three options for revascularization?
angioplasty/ stenting, endarterectomy, and bypass grafting
what is an endarterectomy?
when you actually open the artery and remove the blockage and then patch the hole that is left
what is a complication associated with PAD?
critical limb ischemia (CLI)j
how does critical limb ischemia present?
chronic (more than 2 weeks) ischemic rest pain, ischemic wounds or tissue loss, or gangrene in one or both legs; symptoms are often relieved by hanging hanging the limb over the side of the bed
what are the annual mortality rates of patients with CLI?
~25%
what is the standard approach to screening for AAA?
abdominal duplex US in men aged 65-75 years who have ever smoked more than 100 cigs
what are considered the strong risk factors for a VTE?
major surgery, trauma, cast, or cancer
