Peripheral Artery Disease Flashcards
What are the most significant risk factors for PAD?
Hypertension, hyperlipidemia, diabetes, chronic kidney disease, and smoking
The presence of three or more factors confers a 10 fold increase in PAD risk
What is the hallmark of atherosclerotic lower extremity PAD?
Intermittent claudication
Patient with symptoms of PAD but have a normal resting ABI can be further evaluated with what?
Exercise API testing
What is intermittent claudication?
Intermittenct is the hallmark of PAD and is defined as fatigue, discomfort, cramping, or pain of vascular origin in the calf muscles of the lower extremities that is consistently induced by exercise and consistently relieved within 10 minutes by rest.
Patience with lower extremity PAD recommends patients an increased risk of PAD should be assessed for what three things?
Exertional leg symptoms, ischemic rest pain, and non-healing wounds
What are other common lower extremity findings in patients with PAD?
Hair loss, shiny skin, and muscle atrophy. Arterial ulcerations are characterized by while demarcated, punched out lesions.
What some symptoms in PAD that suggest it’s in advanced disease?
Dependent rubor an elevation power may be present in advance disease
What are some patients at risk for lower extremity peripheral artery disease?
Patient 65 years an older,
50 to 64 years of age plus a risk factor for ATherosclerosis,
younger than 50 years plus diabetes and one additional Rf for atherosclerosis 
Individuals with know ascvd disewse in another vascular bed (abdominal aorta, carotid, coronary, mesenteric, renal, subclavian)
What is good about the ankle brachial index?
It is an expensive and reproducible for assessing the extremity hemodynamics
What is ankle brachial index?
It is the ratio of the highest systolic pressure in each leg obtained at the dorsalis pedis and posterior tibial recurrent arteries in a Doppler probe, to their higher of the right or left arm brachial artery pressure.
What are some history and examination findings suggestive of lower extremity peripheral artery disease?
Diminish lower extremity pulses, impaired walking function, intermittent claudication, ischemic rest pain, lower extremity gangrene, nonhealing lower extremity wound, pallor on elevation of the legs or dependent rumor, vascular bruit
For patients at increased risk of PAD but without suggested history or examination findings, is ABI testing considered reasonable?
Yes
In patience and noncompressible lower extremity vessels with an ABI greater than 1.3, what test can be used?
The toe brachial index can be used
If the physical exam and resting ABI or toe brachial index does not definitely diagnose lower extremity PAT despite history of exertional claudication, then what can be performed?
Exercise API testing may be performed
What is considered normal for ankle brachial index? 
1 to 1.3 is normal
For a tow brachial index when an angle brake index is noncompressible, what is considered abnormal?
Less than 0.7
The AHA and ACC consider the use of what diagnostic test for abdominal aortic aneurysm to be reasonable in patients with symptomatic PAD?
The use of ultrasonography.
What is critical limb ischemia?
In limb-threatening or critical limb ischemia is manifested by chronic -more than two weeks) ischemic rest pain, ischemic wound or tissue loss, or gangrene in one or both of the legs
When does ischemic rest pain typically occur?
Occurs soon after falling asleep, the patient is awakened by burning pain or numbness in the forefoot. Symptoms are relieved by hanging the leg over the side of the bed, triggering dependent rubor of the foot.
Patients with any symptoms of critical limb ischemia should be referred to who?
Referral to a vascular surgeon.
The most significant factors for development of critical limb ischemia or what?
Patients with diabetes, renal failure, heart failure, and prior stroke.
What is acute limb ischemia?
Acute limb ischemia is a medical emergency and describes the abrupt interruption of arterial blood flow to an extremity. The limb presents as cold, painful, and pale extremity with diminished or absent pulses, motor weakness, and sensory impairment.
The acute disruption of arterial flow with acute limb ischemia threatens limb integrity unless what is done?
Unless prompt revascular resization is undertaken.
Patient with acute limb Ischemia should be evaluated by a vascular subspecialist on an emergency basis.
Patience with peripheral artery disease should receive it what? For treatment and prevention
They should receive a comprehensive program of guideline directed medical therapy
What is included in a comprehensive program of guideline directed medical therapy?
Structured exercise, and lifestyle modifications, aim to reduce major adverse cardiac events and major adverse limb events to improve functional status. Smoking cessation is vital in patients who smoke.
What is considered the first line treatment for all patients with peripheral artery disease?
Supervise exercise therapy is the first line treatment for all patients with PAD
Exercise therapy for patients with PAD includes what?
Typically involves patients walking to the point of significant claudication pain, then briefly resting until pain subsides. 
What is the current recommended platelet therapy for patients with PAD?
The AAA/ACC guidelines recommend antiplalate therapy with aspirin alone or clopidogrel alone to reduce the risk of MI, stroke, and vascular death and patient with symptomatic PAD
In asymptomatic patients who have PAS, what is the recommended anti platelet therapy?
Antiplatelet therapy is reasonable to reduce the risk of MI, stroke or vascular death. 
Rct showed no significant reduction in vascular events
In a symptomatic patients with a borderline ABI of zero. 9120. 99, what is the recommendation for anti platelet therapy? 
The usefulness of antiplatelet therapy to reduce the risk of MI, stroke, or vascular death is uncertain
For patients with PAD associated limb symptoms in addition to stable coronary artery disease or cerebral vascular disease, the benefit of aspirin or clopidogrel is well establish, what is the recommendation for a dual antiplatelet therapy in the setting?
Dual antiplatelet therapy in the setting is no more effective and his associate with a greater risk of major bleeding
What medication is recommended for patients with a prior MI that can be added to aspirin to further reduce major cv events ?
Brilinta (ticagrelor) 
What classes of medications for cholesterol and anti-hypertensotherapy and recommended for patients with pre referral Ary disease?
Statin medications and ace inhibitors 
Also use ARBs if ace inhibitors are ineffective
What is the recommended Statin therapy for patients with peripheral artery disease?
Atorvastatin (Lipitor)
High intensity Lipitor improves pain free walking distance and community base physical activity in those with intermittent claudication
What effect does angiotensin converting enzyme inhibitors have on pad? 
They directly inhibit the atherosclerotic process and improve vascular endothelial function, independent of their antihypertensive effect 
What vasodilator is recommended for patients with PAD?
Cilostazol (pletal) , this with anti platelet activity is an effective therapy to improve s/s and increase walking distance in pts with claudication
The preoperative evaluation for patients with PhD includes what?
Angiography, to help find location severity of the vascular occlusion into guide selection of appropriate surgical intervention.
In a supervised exercise program, How long is is training and how often per week?
Training is performed a minimum of 30 to 45 minutes per session, at least three times per week. For a minimum of 12 weeks
The five peas are associated with which type of limb ischemia? Acute or chronic
Acute limb ischemia 
What are the five p’s? 
Pain, pallor, pulselessness, paresthesias, paralysis
What is Poikilothermia? 
It means cold
Patients at increased risk of pad are:
Older than 65
Age 50 to 64 with a risk factor for atherosclerosis or a family history of pad.

Age less than 50 with diabetes and one risk factor for atherosclerosis
Individuals with known ASCVD disease
Such as coronary, carotid, AAA, mesenteric artery stenosis
What should be included in the vascular examination for peripheral artery disease?
Pulse palpation, auscultation for femoral bruits, Inspection of the legs and feet.
An interarm blood pressure difference of more than 15 to 20 MM Hg is abnormal and suggestive of what?
suggested of subclavian artery stenosis
What is the initial diagnostic test for patients with peripheral artery disease?
Ankle brachial index
How is the ankle brachial index measured?
It is measured by systolic blood pressures at the arms (brachial artery) and ankles (dorsalis pedis and posterior tibial arteries) in the supine position by using a Doppler device.
The ABI of each leg is calculated by dividing the higher of the dorsalis pedis pressures or posterior tibial pressure by the higher of the right or left arm blood pressure.
What is the cutpoint for noncompressible arteries? For ankle brachial index
ABI greater than 1.4
What is the borderline range for an ankle brachial index?
0.91 to 0.99
What is a normal ankle brachial index?
1.0 to 1.40
What screen test is recommended for patients with symptomatic PAD?
Screening duplex ultrasound for AAA is reasonable and patience with symptomatic PAD
For asymptomatic patients with lower extremity peripheral artery disease, what’s recommended ?
Ankle brachial index testing, resting and with exercise
For patients with claudication what is the recommended testing for peripheral artery disease?
ABI with Fressing and exercise, segmental pressure duplex ultrasound.
What 2 medication classes are effective for treatment of hypertension associate with renal artery stenosis?
Calcium channel blockers and beta blockers
And patience with a clinical trial of abdominal and or back pain, a pulsatile abdominal mass, and hypertension should indicate what?
Immediate surgical evaluation, suspected AAA
Cilostazol is effective in what regards for patients with PAD? 
Improve symptoms and increase walking distance in patients with claudication
How often should a full exam by condition be done in patients with PAD and diabetes?
Biannually
