Peripheral Artery Disease Flashcards
sign of PAD
leg cramps
the number 1 risk factor for PAD
smoking
smoking, diabetes, HTN, TC, CAD, old age, and lifestyle
risk factors for PAD
_____ 16 fold increase in risk for PAD
smoking
10 mg/dl increase in cholesterol causes what percent increase for PAD
10%
___% of the time present with no symptoms
50%
5 main presentations of PAD
- asymptomatic
- claudication
- atypical leg pain
- critical limb ischemia
- acute limb ischemia
cramps in leg that is reproducible w/ exercise and goes away with rest
claudication
ischemic rest pain
nonhealing wound
gangrene
critical limb ischemia
5 P’s of acute limb ischemia
pain
pulselessness
pallor
parasthesias
paralysis
cramping/fatigue/aching in same muscle with exertion and goes away with rest (within 5 min)
claudication
same as claudication except adds tingling, burning, numbness and time to relief takes longer (</= 30min)
pseudoclaudication
typically a diagnosis of lower extremity involvement (but subclavian, carotids involved too)
PAD
common sites of claudication
aorta/iliac
femoral
popliteal
an aching or cramp-like sensation associated with walking/exercise; goes away with rest; predictable
intermittent claudication
ache in toes
pain relieved when legs lowered
absent distal pulses
rubor w/ depression, pallor w/ elevation
risk for limb loss
PAD
during physical exam to dx or rule out PAD, what do you look for
check for pulses
skin changes/hair changes
wounds
ulcer, gangrene (wounds)
severe dx of PAD
PAD diagnostic test that monitors upper and lower extremity BPs
Ankle-Brachial Index
normal ABI
1
150 R arm, 180 L arm, R lower=120 (how to take ABI)
lower extremity/upper
120/180 (take highest #s)
ABI <0.9
PAD
exercise unmasks what
PAD and CAD (vascular steal syndrome)
ultrasound to look for obstruction of blood flow for PAD
doppler US
test that uses I.V. contrast and gets good pictures
CT angiography
what vessels are hard to interpret on CTA
calcified
this test does not use contrast so don’t have to worry about patient with renal failure
MR angiography
L common gone
L common gone
% patients with PAD have significant risk for CHD
50%
first tell patient to make what changes when experiencing claudication
LIFESTYLE
1st line treatment for intermittent claudication
exercise
PDE inhibitor used to treat intermittent claudication
Pletal (Cilostazol)
antiplatelet drugs used to treat intermittent claudication
Aspirin
Clopidogrel (Plavix) if allergic to ASA
statins
prevents progression of plaque
Aspirin
what else can a patient do to prevent ischemic events
STOP smoking
if exercise and drug therapy are not helping, then what
surgery
main surgery for intermittent claudication if favorable anatomy of patient
CABG
surgery done if patient anatomy not favorable for CABG
PCI (stent)
laser atherectomy
hybrid procedure
CABG + PCI
patients w/ acute limb ischemia should undergo what
U/S, CTA and then surgery
seen in young men w/ heavy tobacco use; claudication; ischemia of distal small arteries and veins
Buerger’s disease
affects both arteries and veins
inflamed thrombosis
Buerger Disease
main treatment for buerger disease
complete cessation of smoking
2nd leading cause of death
Carotid artery disease
degree of stenosis is related to ____ related strokes
carotid
60% of patients w/ stenosis is related to ___% stroke w/in 5 years
75%
to prevent strokes and CAD
statins and aspirin
gold standard Rx for carotid stenosis
carotid endarterectomy
other invasive Rx for carotid stenosis
PCI
family history important
smoking
aortic aneurysm
Pulsing can be misleading
Severe, sudden pain in abd or back
Rare: feet pain
aortic aneurysm
to dx AAA
exam
US
CTA
