Peripheral Arterial Vascular Diseases Flashcards
What are the symptoms of thoracic outlet syndrome? How is it treated?
Thoracic outlet obstruction involves symptoms caused by obstruction of the nerves or blood vessels that serve the arm as the neurovascular bundle passes from the thoracocervical region to the axilla. Affected patients have upper extremity paresthesias (nerve impingement), weakness, cold temperature (arterial compromise), edema, and/or venous distention (venous compromise). The absence of central nervous system symptoms helps to differentiate this condition from subclavian steal syndrome. Causes include cervical ribs (ribs arising from a cervical vertebrae that are usually asymptomatic but may compromise subclavian blood flow) or muscular hypertrophy (classic in young male weightlifters). Treat with surgical intervention (e.g., cervical rib resection).
Define Leriche syndrome. For what is it a marker?
Leriche syndrome is the combination of claudication in the buttocks, buttock atrophy, and impotence in men, and is due to aortoiliac occlusive disease. Most patients need an aortoiliac bypass graft.
Define claudication. What are the associated physical findings?
Claudication is pain, usually in the lower extremity, brought on by exercise and relieved by rest. It occurs with severe atherosclerotic disease and is the equivalent of angina for the extremities. Associated physical findings include cyanosis (with dependent rubor), atrophic changes (thickened nails, loss of hair, shiny skin), decreased temperature, and decreased (or absent) distal pulses.
How are patients with claudication managed?
The best treatment is conservative: cessation of smoking, exercise, and good control of cholesterol, diabetes, and hypertension. Antiplatelet agents are warranted in patients with claudication. Aspirin is preferred, but clopidogrel may be used for patients who cannot tolerate aspirin. Cilostazol may be used for the treatment of intermittent claudication. Beta-blockers may worsen claudication (as a result of beta2-receptor blockade) but the benefits may outweigh the risks in some patients (e.g., prior MI). If claudication progresses to pain at rest (forefoot pain, generally at night, that is classically relieved by hanging the foot over the edge of the bed) or interferes with lifestyle or work obligations, perform arterial duplex ultrasonography for diagnosis and use angioplasty or surgical revascularization for treatment. Because claudication and peripheral vascular disease are general markers for atherosclerosis, check for other atherosclerosis risk factors.
What is the probable cause of sudden onset of SEVERE foot pain in patients with no previous history of foot pain, trauma, or associated chronic physical findings?
This scenario may indicate an embolus (look for atrial fibrillation; the pulse may be absent in the affected area) or compartment syndrome (common after revascularization procedures).
