Peripheral Artery Disease Flashcards
What is the screening process for peripheral artery disease?
- Ankle Brachial Index
- USPSTF: I - uncertain
- AHA/ACC (class 1, level of evidence B)
- age 65 and older
- age 55 with risk factors (Diabetes, Smokers
Describe the ABI procedure
What are the ABI values considered
Normal
Borderline
Mild-to-moderate disease
severe disease
noncompressible
- Normal
- 1.00-1.29
- Borderline
- 0.91-0.99
- Mild-to-moderate disease
- 0.41-0.90
- severe disease
- <0.40
- noncompressible
- > 1.30
If you get an abnormal ABI, what are the next steps?
- Segmental pressures
- checking a bunch of different pressures so you know where to drop off is
- Arterial dopplers
- elevated velocity indicated a narrowing
- CT angiography
- MR angiography
- Traditional angiography
** notice the significant difference in blood flow between the two legs
What is different in the sound & ECG of a healthy artery vs. one with peripheral artery disease?
- Diseased
- biphasic (systolic & diastolic)
- Healthy
- triphasic
- (systolic, diastolic & elastic recoil of aorta)
- triphasic
What is the provided image?
on table angiogram of a patient with peripheral artery disease
look how lumpy & bumpy the left common iliac (on right side of image)
What is abnormal about the provided angiogram?
The femoral artery disapears in the middle of the right leg (left side of image) w/ lots of collateral brahces supplying the popliteal
the left leg does not show very strong outflow into the popliteal artery
No peroneal arteries on either side, so loss of half of the lower leg blood supply on both side
What is wrong with the provided angiogram
can see external iliac over the femur, but as it goes under the inguinal ligament, it disappears as it should turn into the common femoral artery
Also, you don’t see any collateral arteries
could be limb threatening– post 6 hours, would have to amputate
The provided image is an example of what type of imaging?
What is wrong with the provided imaging?
3D recontstruction with CT angiogram
left common iliac is bordering on aneurysmal
not really distinct internal inguinal arteries
notice the low flow feeding both of the thighs
What is the clinical presentation of peripheral artery disease?
- claudication (pain and/or cramping)
- usually one segment down from stenosis
- reproducible
- critical limb ischemia
- cold, dead leg/arm
- non-healing ulcers
- have to ask yourself, is there adequate flow?
What are the goals of treatment for peripheral artery disease?
- preserve/improve functional capacity
- cardiovascular risk reduction
- preserve limb viability
What are the treatment strategies for peripheral artery disease are used to increase maintian or increase functional capacity?
- Supervised exercise program (PT)
- atorvastatin
- cilostazol
- platelet aggregation inhibitor -not anticoagulant
- does do anything for CV risk reduction or preserving limb viability
- nafronyl (in europe)
- surgical revascularization
- electively get by-pass or stent
What are the treatment strategies for peripheral artery disease that are used to reduce cardiac risk?
- treatment of comorbidities (diabetes, hypertension, hypelipidemia)
- Smoking cessation
- Antiplatelets
- Aspirin
- Copidigrel
- Dual antiplatelet therapy, may be considered, if symptomatic
- Vorapaxar
- Warfarin not better than aspirin alone
What are the treatment strategies for peripheral artery disease that are used to preserve limb viability?
- no clear evidence to support a specific strategy
- antiplatelets
- statins
- Supervised exercise plan
- surgical revascularization
What type of drug is Voripaxar?
Mechanism of action?
Why is it used?
Aderse effects?
- Platelet aggregation inhibitor
- antagonist for PAR-1 thrombin receptor
- Reduces risk of major at-risk cardiovascular events (MACE),
- increases risk of hemorrhage
