Peripheral Arterial Disease Lecture 1

Question 1

three categories of PAD

Answer 1

• aortoiliac
• femoropopliteal
• tibioperoneal

Question 2

routinely, there must be a ____% diameter reduction before symptoms occur.

Answer 2

50

Question 3

most common site of PAOD

Answer 3

aortoiliac

Question 4

most common site for stenosis

Answer 4

bifurcation

Question 5

Chronic occlusive disease …

Answer 5

• claudication

- pain in muscle (progressive) w/exercise in calf, thigh or buttock, relieved by rest

Question 6

disease is usually _____ to location of symptom

Answer 6

proximal

Question 7

symptoms occurs _____ to disease

Answer 7

distal

Question 8

during the periods of inadequate perfusion, a cramping or aching sensation occurs in the muscle

Answer 8

claudication

Question 9

what is pseudoclaudication?

Answer 9

neurogenic: nerve compression; mot reproducible or musculoskeletal

Question 10

occlusive disease reaches the point that there is reduced flow at rest

Answer 10

chronic occlusive disease

Question 11

symptoms of end stage level of chronic occlusive disease

Answer 11

-rest pain or ischemic rest pain (forefoot, heel, and toes)

Question 12

chronic symptoms usually occur when limb is ________, usually when sleeping, when bp is low and limb is elevated

Answer 12

not dependant

Question 13

when supine BP is decreased by ____%

Answer 13

30

Question 14

less than ____ mmHg = tissue loss, critical

Answer 14

60

Question 15

most severe form of arterial disease

Answer 15

chronic

Question 16

acute arterial disease is usually caused by …

Answer 16

embolus, thrombosis, or trauma

Question 17

five P’s associated with acute arterial occlusion

Answer 17

pain, pallor, pulsessness, paresthesia, paralysis

Question 18

6th P…

Answer 18

poikilothermia/polar (cold)

Question 19

7th P…

Answer 19

purplish

Question 20

vasospastic/cold sensitivity disorders

Answer 20

-Raynaud’s

Question 21

diabetes is associated with what syndrome?

Answer 21

monkeburg’s

Question 22

arterial sclerosis involving peripheral arteries especially in the legs (medial lay)

Answer 22

monkeburg’s syndrome

Question 23

most common pathology condition, thickening, hardening, and loss of elasticity of the artery walls

Answer 23

atherosclerosis aka: arteriosclerosis

Question 24

• caused by obstruction of the terminal aorta
• usually in males, characterized by fatigue in the hips, thighs, or calves on exercising
• absence of pulsation in the femoral arteries, impotence, and often coldness/pallor of lower limbs

Answer 24

Leriche Syndrome***

Question 25

most common site for embolism

Answer 25

-PTA and popliteal

Question 26

most common type of aneurysm

Answer 26

AAA and of AAA fusiform

Question 27

most common site for pseudoaneurysm

Answer 27

right common femoral artery

Question 28

___cm or less "neck" size, no thrombin injection

Answer 28

0.5

Question 29

____% of patients with PAD etiology is atherosclerosis

Answer 29

90

Question 30

Most common type of arteritis

Answer 30

buerger's AKA thromboangiitis Obliterans

Question 31

- media cells become infiltrated with white blood cells - muscular and elastic portions are eroded - fibrosis develops - blood vessel wall weakens and necrosis can occur

Answer 31

vascular arteritis

Question 32

symptoms of arteritis (similar to those seen in atherosclerosis)

Answer 32

- claudication or rest pain - decreased and asymmetrical blood pressure - TIA/stroke symptoms - if in upper extremity; claudication symptoms

Question 33

types of arteritis

Answer 33

- arteritis - Takayasu - temporal - polyarteritis - buerger's (most common)

Question 34

Giant cell arteritis is also known as ...

Answer 34

temporal arteritis

Question 35

inflammatory of the distal segment of the STA typically seen in elderly Caucasian women (70 years or greater)

Answer 35

Giant Cell Arteritis

Question 36

symptoms of Giant Cell Arteritis

Answer 36

- asymmetric upper extremity bp - temporal headaches - tenderness over superficial temporal artery - decreased pulse - could also be: axillary/brachial/subclavian vessels - cord-like structure over superficial temporal artery - aching or stiffness in the neck - headaches - jaw claudication

Question 37

- non-atherosclerotic - associated with heavy cigarette smokers (and chew tobacco) - occurs primarily in men < 45years old - prevalent in India - affects small and medium-sized arteries of upper and lower extremities

Answer 37

buerger's disease AKA thromboangitis obliterans (TOA)

Question 38

buergers disease is always ________

Answer 38

bilateral, with one side worse than the other

Question 39

- occlusions of the distal arteries - rest pain and ischemic ulceration - can cause superficial thrombophlebitis and numbness and tingling in the hands and feet - can consist of ischemic digital ulcers

Answer 39

buerger's disease/ thromboangitis obliterans (TOA)

Question 40

- rare complication of radiation therapy for cancer - results in perivascular fibrosis, inflammation, and acceleration of atherosclerosis - may be difficult to distinguish from atherosclerosis - pt often presents with claudication several months after ration treatment

Answer 40

radiation-induced arteritis

Question 41

- congenital narrowing of the ascending or thoracic aorta (can effect abdominal) - causes bilateral decrease pluses and segmental pressures - LE ischemia - on RVT think "youth"

Answer 41

coarctation of aorta

Question 42

media is weakened; intima develops tear through wich blood leaks into the media (false lumen)

Answer 42

dissection (aorta) trama

Question 43

John Ritter's cause of death

Answer 43

aortic dissection

Question 44

- primary and secondary - commonly affecting young women - intermittent digital ischemia caused by digital arterial spasm from exposure to cold / emotional stress - bilateral

Answer 44

Raynaud's phenomenon

Question 45

primary Raynaud's syndrome

Answer 45

intermittent vasospasm, symptoms unassociated with any other disease process/idiopathic caused by cold or emotional stress

Question 46

secondary Raynaud's syndrome

Answer 46

- connective tissue disorders - arterial occlusive disease one or more digits - TOS - trauma - blood disorders - disease that blocks the arteries

Question 47

compression of an artery between two muscles

Answer 47

entrapment syndrome

Question 48

the two types of entrapment syndrome

Answer 48

-popliteal and thoracic outlet syndrome

Question 49

- compression of pop. artery by the medial head of gastrocnemius muscle or fibrous bands - found in young men - bilateral in a third of cases - symptomatic arterial occlusion or intermittent claudication

Answer 49

popliteal entrapment syndrome

Question 50

normotensive

Answer 50

normal bp

Question 51

- inflammation of the periosteum where the muscle fibers are attached - pain in the shin area - treatment: rest, ice, low-impact exercise

Answer 51

shin splints

Question 52

- rare condition affects the shoulder and UE in young and middle-aged adults - abnormality w/neurovascular bundle compression by the shoulder structures, usually occurs only in certain positions - symptoms due to neurogenic compression of the brachial plexus (97%) * **** non-threatening

Answer 52

Thoracic Outlet Syndrome

Question 53

TOS is the area where the _______ artery and ________ leave the chest and pass between the anterior and middle scalene muscle over the 1st rib and underneath the clavicle. This is a compact anatomical area. seen in muscular people.

Answer 53

subclavian, brachial plexus

Question 54

symptoms of TOS

Answer 54

- aching discomfort of shoulder, radiates down the forearm - cold, painful, numbness, that varies with position - parasthesia, due to compression of nerves - arm claudication - 90% are neurogenic

Question 55

new non-invasive assessment of TOS

Answer 55

White Hand Sign****

Question 56

how is TOS diagnosised

Answer 56

- PPG and or Doppler waveforms utilized to monitor any changes - attach PPG to index finger or CW Doppler to radial artery - resting waveforms are obtained, place arm in various positions - abnormal changes with waveform with movement of arm

Question 57

what position is used to diagnose TOS

Answer 57

Adison position

Question 58

treatment for TOS

Answer 58

surgical removal of cervical rib and division of fibrous band to relieve compression

Question 59

livedo reticularis***

Answer 59

purple patches on skin

Question 60

what are the skin changes in TOS

Answer 60

- pallor: deficient in blood supply - rubor: hyperemia, blood pooling in the arterioles; dark red - cyanosis: deoxygenated blood

Question 61

what are the temperature changes with TOS

Answer 61

- symmetrical coolness = vasoconstriction | - asymmetrical coolness = arterial insufficiency