Peripheral Arterial Disease Lecture 1 Flashcards
three categories of PAD
- aortoiliac
- femoropopliteal
- tibioperoneal
routinely, there must be a ____% diameter reduction before symptoms occur.
50
most common site of PAOD
aortoiliac
most common site for stenosis
bifurcation
Chronic occlusive disease …
- claudication
- pain in muscle (progressive) w/exercise in calf, thigh or buttock, relieved by rest
disease is usually _____ to location of symptom
proximal
symptoms occurs _____ to disease
distal
during the periods of inadequate perfusion, a cramping or aching sensation occurs in the muscle
claudication
what is pseudoclaudication?
neurogenic: nerve compression; mot reproducible or musculoskeletal
occlusive disease reaches the point that there is reduced flow at rest
chronic occlusive disease
symptoms of end stage level of chronic occlusive disease
-rest pain or ischemic rest pain (forefoot, heel, and toes)
chronic symptoms usually occur when limb is ________, usually when sleeping, when bp is low and limb is elevated
not dependant
when supine BP is decreased by ____%
30
less than ____ mmHg = tissue loss, critical
60
most severe form of arterial disease
chronic
acute arterial disease is usually caused by …
embolus, thrombosis, or trauma
five P’s associated with acute arterial occlusion
pain, pallor, pulsessness, paresthesia, paralysis
6th P…
poikilothermia/polar (cold)
7th P…
purplish
vasospastic/cold sensitivity disorders
-Raynaud’s
diabetes is associated with what syndrome?
monkeburg’s
arterial sclerosis involving peripheral arteries especially in the legs (medial lay)
monkeburg’s syndrome
most common pathology condition, thickening, hardening, and loss of elasticity of the artery walls
atherosclerosis aka: arteriosclerosis
- 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
Leriche Syndrome***
most common site for embolism
-PTA and popliteal
most common type of aneurysm
AAA and of AAA fusiform
most common site for pseudoaneurysm
right common femoral artery
___cm or less “neck” size, no thrombin injection
0.5
____% of patients with PAD etiology is atherosclerosis
90
Most common type of arteritis
buerger’s AKA thromboangiitis Obliterans
- media cells become infiltrated with white blood cells
- muscular and elastic portions are eroded
- fibrosis develops
- blood vessel wall weakens and necrosis can occur
vascular arteritis
symptoms of arteritis (similar to those seen in atherosclerosis)
- claudication or rest pain
- decreased and asymmetrical blood pressure
- TIA/stroke symptoms
- if in upper extremity; claudication symptoms
types of arteritis
- arteritis
- Takayasu
- temporal
- polyarteritis
- buerger’s (most common)
Giant cell arteritis is also known as …
temporal arteritis
inflammatory of the distal segment of the STA typically seen in elderly Caucasian women (70 years or greater)
Giant Cell Arteritis
symptoms of Giant Cell Arteritis
- 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
- 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
buerger’s disease AKA thromboangitis obliterans (TOA)
buergers disease is always ________
bilateral, with one side worse than the other
- 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
buerger’s disease/ thromboangitis obliterans (TOA)
- 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
radiation-induced arteritis
- congenital narrowing of the ascending or thoracic aorta (can effect abdominal)
- causes bilateral decrease pluses and segmental pressures
- LE ischemia
- on RVT think “youth”
coarctation of aorta
media is weakened; intima develops tear through wich blood leaks into the media (false lumen)
dissection (aorta) trama
John Ritter’s cause of death
aortic dissection
- primary and secondary
- commonly affecting young women
- intermittent digital ischemia caused by digital arterial spasm from exposure to cold / emotional stress
- bilateral
Raynaud’s phenomenon
primary Raynaud’s syndrome
intermittent vasospasm, symptoms unassociated with any other disease process/idiopathic
caused by cold or emotional stress
secondary Raynaud’s syndrome
- connective tissue disorders
- arterial occlusive disease one or more digits
- TOS
- trauma
- blood disorders
- disease that blocks the arteries
compression of an artery between two muscles
entrapment syndrome
the two types of entrapment syndrome
-popliteal and thoracic outlet syndrome
- 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
popliteal entrapment syndrome
normotensive
normal bp
- inflammation of the periosteum where the muscle fibers are attached
- pain in the shin area
- treatment: rest, ice, low-impact exercise
shin splints
- 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
Thoracic Outlet Syndrome
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.
subclavian, brachial plexus
symptoms of TOS
- 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
new non-invasive assessment of TOS
White Hand Sign**
how is TOS diagnosised
- 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
what position is used to diagnose TOS
Adison position
treatment for TOS
surgical removal of cervical rib and division of fibrous band to relieve compression
livedo reticularis***
purple patches on skin
what are the skin changes in TOS
- pallor: deficient in blood supply
- rubor: hyperemia, blood pooling in the arterioles; dark red
- cyanosis: deoxygenated blood
what are the temperature changes with TOS
- symmetrical coolness = vasoconstriction
- asymmetrical coolness = arterial insufficiency
