Peripheral Vascular/Arterial Disease - Hunt Flashcards
identify the signs, symptoms, and approach to the diagnosis of:
Abdominal Aortic Aneurysm
Signs & Symptoms
- most are Asymptomatic and discovered on routine exam or chest x-ray or ultrasound
- expanding AAA: sudden, severe and constant low back, flank, abdominal or groin pain
- syncope may be chief complaint
Diagnosis
- pulsatile abdominal mass
- plain x-ray
- CT
- MRI
- Ultrasound is gold standard
Treatment
- surgery
- any symtomatic aneurysm
- asymptomatic aneurysm > 5 cm
- any aneurysm that has shown an increase in size over last 6 months
- stents
*identify the signs, symptoms, and approach to the diagnosis of the following: *
Acute arterial occlusion
SIGNS - recognition is vital
- Pain hearlds onset of ischemia
- Paralysis and Parasthesia are most important
- Pallor - indicates decreased circulation
- Absence of Pulses confirms the diagnosis and localizes the point of occlusion
Causes
- embolism
- trauma
- thrombosis
TX
- emergent referral
- immediate anticoagulation
- embolectomy
Identify this condition and describe the management:
pt presents with pain in his leg and that it feels like it is “asleep”
exam reveals absence of dorsal pedis pulse
Acute Arterial Occlusion
treatment:
- emergent referral
- immediate anticoagulation
- embolectomy
ANKLE BRACHIAL INDEX
- measure pt’s brachial BP
- measure ankle BP
- divide ankle by brachial
- 0.9-1.0 = normal
- 0.7-0.9 = mild
- 0.5-0.7 = moderate
- < 0.5 = severe
identify the signs, symptoms, and approach to the diagnosis of:
Aortic Dissection
event of sudden onset in which blood leaves the normal aortic channel through a usually discrete point of exit (intimal tear) - dissects into layers of the aorta
causes
- medial degneration
- Marfan Syndrome
- bicuspid aortic valve
- dilated ascending aorta
- aortic coarctation
- systemic arterial hypertension
clinical features
- sudden death
- hypovolemic shock
- sudden severe arterial hypertensive event
- radiating pain through to back, neck or arms, occlusion of a major vessel
diagnosis and treatment
- CXR
- Echo
- CT or MRI
- Aortography
Identify this condition and describe the management:
pt is a 60 year old female reporting radiating pain to her back, neck and arms
pt has decreased blood pressure, weak thready pulse, pale skin, and is sweating
Aortic Dissection
diagnosis: CXR, echo, CT or MRI, aortography
tx: immediate surgical referral
Aortoiliac PVD
- claudication involving calf, thigh and buttock
- impotence
- rest pain, ulceration and gangrene not common
- forth, fifth to sixth decade of life
identify the signs, symptoms, and approach to the diagnosis of:
Carotid Artery Stenosis
Signs & Symptoms
- transient ischemic attacks
- transient focal neurological deficits
- all symptoms resolve within 24 hours
- ataxia
- vertigo
- drop attacks
- diplopia
- visual blurring
- amaurosis fugox
- bruits over carotids
Diagnosis and Treatment
- doppler ultrasound
- angiography
- medical vs. surgical
Identify this condition and describe the management:
pt presents with complaints of vertigo and visual blurring
exam reveals pt burits on ascultation of carotid arteries
Carotid Artery Stenosis
- medical and surgical treatment
Chronic Venous Insufficiency
- dysfunction of valves in the superficial and/or communicating veins
- dysfunction of valves
- deep venous outflow obstruction
- muscle dysfunction
identify the signs, symptoms, and approach to the diagnosis of:
Deep Vein Thrombosis
Signs and Symptoms
- painful swollen leg
- temperature
- positive Homan’s sign
- positive risk factor
Diagnosis
- duplex scanning
- venography
Treatment
- elevation and rest
- thrombolytic agents
- heparin
- lovenox
- coumadin
Diagnostic Testing of Venous Ulcers
- LAB - CBC, blood sugar, ESR, albumin
- culture
- biopsy
- plain film radiographs
- test for peripheral arterial disease
- duplex ultrasonography
Femoropopliteal PVD
- common in smokers
- tissue necrosis more common
- rest pain more common
- more common in older individuals
History - Peripheral Artery Disease
- pain
- rest-pain poor prognosis sign
- intermittent claudication
- most common complaint
- due to limb ischemia
- highly specific symptom, virtually diagnostic
- smoking history
- diabetes
- cardiac disorders
- trauma
- familial disease
- occupational history
- impotence
- drugs
Indications for Surgical Revascularization - Peripheral Artery Disease
- pain at rest
- ischemic ulcers or gangrene
- atheroembolic (trash foot)
- low ABI
- claudications at short distance, worsening symptoms
Ischemic Leg Ulcers
- little or no bleeding
- irregular edge, poor granulation tissue
- distal location on dorsum of foot & toes
- severe pain
- trophic changes of chronic ischemia
- distal pulses are weak or gone
Stasis Ulcers
- venous ooze with manipulation
- shallow, irregular shape, granulating base, rounded edges
- stasis dermatitis
- located lower third of leg
- mild pain, relieved by elevation
