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Vascular 3 > Peripheral Arterial System > Flashcards

Peripheral Arterial System Flashcards

1
Q

Risk factors for peripheral arterial disease.

A

Diabetes, HTN, hyperlipidemia, CAD, previous CVA or MI, smoking, age, male, family history, obesity, sedentary lifestyle, history of radiation, elevated homocysteine, excessive C-reactive protein

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2
Q

Physical signs

A

Skin changes, palpations (pulses), auscultation (bruit), limb pressure differences

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3
Q

Pallor

A

Pale colour due to deficient blood supply

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4
Q

Rubor

A

Red or discoloured skin from dilated or damaged vessels

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5
Q

Dependent rubor

A

Pallor when elevated, rubor when hanging

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6
Q

Cyanosis

A

Blueish colour of the skin

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7
Q

Trophic changes

A

Due to lack of nourishment, shiny, scaly skin with thick toenails and hair loss

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8
Q

What difference in pressure could indicated disease?

A

20mmHg

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9
Q

What are some signs and symptoms of peripheral arterial disease?

A

Intermittent claudication, Ischemic rest pain, necrosis, paralysis (weakness), parasthesia, poikilothermia (cold limbs), gangrene/ulceration, previous therapeutic vasc procedure

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10
Q

How would you differentiate claudication and pseudoclaudication?

A

Claudication is reproducible, pseudo is not

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11
Q

What are 3 mechanisms of disease?

A

Atherosclerosis, embolism, aneurysm

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12
Q

What are the uses of peripheral arterial duplex testing?

A

Determine if there is a stenosis/occlusion or aneurysms, evaluate bypass graft, locate stenotic lesions pre-surgery, follow up post-surgery

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13
Q

What arteries are assessed in an LE arterial duplex protocol?

A

Distal external iliac, common femoral, common femoral bifurcation, superficial femoral, popliteal, bifurcation of the tibial-peroneal trunk and anterior tibial

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14
Q

What arteries are asses in an UE protocol?

A

Subclavian, axillary, brachial, radial, ulnar, palmar if needed

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15
Q

What are normal peak systolic velocities of the UE arteries?

A

Subclavian and axillary- 70-120cm/s
Brachial- 50-120cm/s
Radial and ulnar- 40-90 cm/s
Palmar and digits- lower

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16
Q

When a stenosis is seen, where do you obtain your waveforms?

A
  • 2cm prox
  • highest PSV
  • distal to the stenosis
17
Q

What are normal PSV of the LE arteries?

A 
Triphasic flow
External iliac: 120 +/- 22 cm/s
Common femoral: 114 +/- 25 cm/s
Superficial femoral (SFA) prox: 91 +/- 14
SFA distal: 94 +/- 14
Popliteal: 69 +/- 13
18
Q

What is a biphasic arterial signal?

A

Strong forward flow in systole, loss of flow in early diastole, decrease in late diastole

19
Q

What is a monophasic arterial signal?

A

Decreased pulsatility and no reversed flow in late systole, diastolic flow may or may not be seen, blunted systolic part

20
Q

When is a monophasic signal commonly seen?

A

Distal to a hemodynamically significant stenosis or occlusion

21
Q

What % stenosis causes a velocity increase of more than double?

A

> 50%

22
Q

What % stenosis causes a velocity increase to triple?

A

> 70%

23
Q

What type of waveform is seen with a distal occlusion?

A

Staccato

24
Q

What are some medical treatment for arterial disease?

A

Change lifestyle factors, exercise, antiplatelets, anticoagulants, antithrombolytics

25
Q

What are some surgical treatments for arterial disease?

A

Bypass grafting, artherectomy, resectioning, sympathectomy, amputation

26
Q

What are some endovascular treatments for arterial disease?

A

Angioplasty, stent, intra-arterial directed thrombolysis

27
Q

Pulsating hematoma from a leaking artery and confined by surrounding tissue and has a communicating channel between the main artery and pulsating mass

A

False (pseudo) aneurysm

28
Q

Inflammation of the arterial

A

Arteritis

29
Q

Most common arteritis?

A

Buerger’s disease

30
Q

Congenital narrowing of the thoracic aorta that may result in LE ischemia

A

Aorta coarctation

31
Q

Two types of Raynaud’s

A
  1. Primary (idiopathic, spastic Raynaud’s syndrome)

2. Secondary (obstructive)

32
Q

Swelling within the osteofascial compartments that causes a comprise of blood flow

A

Compression/entrapment syndromes

33
Q

Focal stenosis or occlusion of the popliteal artery compressed by a cyst

A

Adventitious cystic disease

34
Q

Compression of the subclavian artery/vein/nerves that lead to hand and arm ischemia and pain/weakness

A

Thoracic outlet syndrome

35
Q

Communication between an artery and an adjacent vein

A

AV fistula

36
Q

Toe ischemia due to micro-emboli

A

Blue toe syndrome

37
Q
  1. Establish baseline hemodynamics post revasccularization
  2. Identify correctable lesions before graft thrombosis
  3. Provide info to aid in decisions regarding treatment alternatives
A

Role of Doppler in the study of bypass grafts

38
Q

What are the 4 graft locations?

A
  1. Aorto-iliac
  2. Aorto-fem
  3. Ax-fem
  4. Fem-fem
39
Q

Mean PSVs in LE arteries:

A

External iliacs: 120 +/- 22 cm/s
Common femoral: 114 +/- 25 cm/s
SFA (prox): 91 +/- 14 cm/s.

SFA (dist): 94 +/- 14 cm/s

Pop: 69 +/- 13 cm/s

Vascular 3 (2 decks)

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