Peripheral Vascular Disease Flashcards

Question

What is the purpose of Buerger's test in assessing peripheral arterial disease?

Answer 1

Answer: * is used to assess peripheral arterial disease in the leg. * It helps evaluate the adequacy of arterial blood supply by observing the presence of pallor when the legs are lifted to a certain angle and the color changes (blue and dark red) when the legs are allowed to hang over the side of the bed.

Answer 2

Answer: Arterial ulcers and venous ulcers can be distinguished based on the following features: 1. Arterial ulcers are smaller and deeper than venous ulcers. 2. Arterial ulcers have well-defined borders and a "punched-out" appearance, while venous ulcers have irregular, gently sloping borders. 3. Arterial ulcers occur peripherally, such as on the toes, while venous ulcers commonly affect the gaiter area of the leg (mid-calf down to the ankle). 4. Arterial ulcers have reduced bleeding and are typically painful, while venous ulcers are less painful. 5. Arterial ulcers are caused by ischaemia due to inadequate blood supply, whereas venous ulcers are caused by impaired drainage and pooling of blood in the legs. 6. Arterial ulcers may be associated with other signs of arterial insufficiency, such as decreased pulses, whereas venous ulcers may be associated with signs of chronic venous insufficiency, such as haemosiderin staining and venous eczema.

Answer 3

1. Ankle-brachial pressure index (ABPI): ABPI is the ratio of systolic blood pressure (SBP) in the ankle compared to the SBP in the arm. It is measured using a **Doppler probe.** ABPI values can indicate the severity of peripheral arterial disease. 2. Duplex ultrasound: This test uses ultrasound to assess the speed and volume of blood flow in the arteries. 3. Angiography: Angiography, performed using CT or MRI, involves the use of contrast to visualize the arterial circulation and identify any blockages or stenosis.

Answer 4

***Lifestyle changes*** ***Exercise training*** ***Medical*** treatments: - Atorvastatin 80mg - Clopidogrel 75mg once daily (aspirin if clopidogrel is unsuitable) - Naftidrofuryl oxalate (5-HT2 receptor antagonist that acts as a peripheral vasodilator) ***Surgical*** options: - ***Endovascular angioplasty and stenting*** - ***Endarterectomy*** – cutting the vessel open and removing the atheromatous plaque - ***Bypass surgery*** – using a graft to bypass the blockage

Answer 5

Patients with critical limb ischaemia require urgent referral to the vascular team. They require **analgesia** to manage the pain. Urgent revascularisation can be achieved by: - ***Endovascular angioplasty and stenting*** - ***Endarterectomy*** - ***Bypass surgery*** - ***Amputation*** of the limb if it is not possible to restore the blood supply

Answer 6

Patients with acute limb ischaemia need an urgent referral to the on-call vascular team for assessment. Management options include: - ***Endovascular thrombolysis*** – inserting a catheter through the arterial system to apply thrombolysis directly into the clot - ***Endovascular thrombectomy*** – inserting a catheter through the arterial system and removing the thrombus by aspiration or mechanical devices - ***Surgical thrombectomy*** – cutting open the vessel and removing the thrombus - ***Endarterectomy*** - ***Bypass surgery*** - ***Amputation*** of the limb if it is not possible to restore the blood supply

Answer 7

A: The lower extremity vessels are more commonly affected, including the aorta, iliac, femoral, popliteal, tibial, and pedal vessels.

Answer 8

A: When blood flow is reduced, tissues in the affected area receive less oxygen and nutrients, leading to ischemia (lack of blood supply) in the muscles and skin.

Answer 9

A: If a large plaque obstructs the blood flow, the tissues beyond that point become more susceptible to reduced oxygen and nutrient delivery, increasing the risk of ischemia.

Answer 10

A: * Increased physical activity, such as walking or exertional activities , * increases the oxygen demand of the muscles. In PAD, where there is already reduced oxygen supply, * this imbalance between demand and supply worsens ischemia and can lead to further complications.

Answer 11

A: If ischemia persists without intervention, it can progress to the death of the affected tissue, resulting in tissue infarction (cell death due to lack of blood supply).

Answer 12

A: The two main causes are thrombosis and embolism.

Answer 13

A: * Thrombosis is the chronic type of PAD that progresses gradually, while * embolism is an acute issue where a clot dislodges and blocks a vessel suddenly.

Answer 14

A: hypertension, high LDL (low-density lipoprotein) or low HDL (high-density lipoprotein), smoking, diabetes mellitus, and old age.

Answer 15

A: Stent thrombosis can occur if a patient with PAD, who has undergone stent placement, does not comply with the prescribed medications such as aspirin and Plavix (Clopidogrel). Non-compliance increases the risk of thrombosis within the stent.

Answer 16

A: Causes of embolic PAD include atrial fibrillation, left ventricular thrombus (due to myocardial infarction or left heart failure), abdominal aortic aneurysm (AAA), popliteal aneurysm, vasculitis (inflammation of the vessels), trauma, and compartment syndrome.

Answer 17

A: If a piece of a clot breaks off from an abdominal aortic aneurysm or popliteal aneurysm, it can become lodged in a vessel downstream, causing decreased oxygen and nutrient supply distal to the clot.

Answer 18

A: Compartment syndrome refers to the compression of vessels, leading to reduced perfusion in the affected area.

Answer 19

A: Reduced blood flow to the muscles in PAD leads to insufficient oxygen and nutrient supply, resulting in muscle pain.

Answer 20

A: The location of pain can indicate which vessels may have plaques or be occluded. It helps in identifying the affected areas and potential complications.

Answer 21

A: Patients may experience pain in the hip and buttocks region, which can radiate down the entire extremity. Diminished femoral, popliteal, and pedal pulses may also be observed. Erectile dysfunction may occur due to compromised genital artery blood flow.

Answer 22

A: The femoral and popliteal arteries are affected. This can cause calf pain and compromise blood flow to the calves.

Answer 23

A: Plaques developing in the calves can lead to reduced blood flow to the foot, resulting in foot pain.

Answer 24

A: The pain in PAD is often described as claudication pain, which is pain that occurs due to vascular issues.

Answer 25

A: Exertion increases the oxygen demand of the muscles. In PAD, where there is already reduced oxygen supply, the combination of increased demand and inadequate supply leads to ischemia and worsens the pain.

Answer 26

A: Resting can decrease the demand for oxygen, leading to an improvement in pain. If pain worsens with exertion but improves during rest, it indicates that the blood supply is suboptimal but sufficient for resting conditions.

Answer 27

A: If pain occurs at rest in PAD, it indicates that the blood supply to the affected area is extremely low. Even without an increase in oxygen demand, the pain worsens due to severe ischemia.

Answer 28

A: Buerger's sign refers to the change in color and increased pain in the legs when they are elevated. It occurs because the blood flow is working against gravity. If the pain improves when the legs hang down, it is a sign of resting claudication.

Answer 29

A: Critical limb ischemia occurs when there is a severe reduction in blood supply to the limb, posing a threat to its viability. It is characterized by rest pain persisting for more than two weeks, arterial ulcers, or gangrene.

Answer 30

A: Critical limb ischemia indicates a severe reduction in oxygen supply to the limb, with a risk of infarction. In contrast, claudication pain is related to exercise and is relieved with rest.

Answer 31

A: Plaque or embolus occluding the blood flow can result in reduced or absent pulses distal to the affected area.

Answer 32

A: Bruits are abnormal sounds caused by turbulent blood flow. In PAD, the presence of plaque or embolus increases the turbulence of blood flow, leading to increased bruits that can be auscultated.

Answer 33

A: Reduced oxygen supply in PAD leads to decreased ATP production in muscles, resulting in impaired muscle contraction. Over time, this can lead to muscle atrophy.

Answer 34

A: Muscle atrophy occurs in PAD due to the decreased oxygen supply, which hampers ATP production necessary for muscle contraction. The muscles become weaker and may shrink in size over time.

Answer 35

A: pale and cold extremities, hair loss, thin skin, and thin nails.

Answer 36

A: Decreased blood flow in PAD leads to pale skin due to reduced oxygen supply. The skin also becomes colder because blood carries heat, and decreased blood flow results in less heat reaching the skin.

Answer 37

A: Hair loss occurs in PAD due to the decreased oxygen and nutrient supply to the hair follicles. Inadequate blood flow can disrupt normal hair growth and result in hair loss.

Answer 38

A: is caused by the insufficient oxygen and nutrient supply to the tissues, which affects their ability to regenerate and maintain normal thickness.

Answer 39

A: * Arterial ulcers are ulcers that develop due to impaired blood flow in arteries. * They are typically punched out, dry, and located on pressure points such as toes or lateral malleolus. * Arterial ulcers differ from venous ulcers in their appearance and location.

Answer 40

A: * Dry gangrene is characterized by black discoloration and a lack of erythema or exudate. * If the condition worsens, it can progress to wet gangrene, which involves erythema, infection, exudate, and further black discoloration. * Wet gangrene is a severe condition that can lead to sepsis if not treated promptly.

Answer 41

A: progress from decreased color (pallor), cold extremities, and reduced hair to thin skin, thin nails, arterial ulcers, dry gangrene, and, in severe cases, wet gangrene. These manifestations represent the worsening effects of inadequate oxygen supply to the tissues.

Answer 42

A: The common causes of acute limb ischemia are embolus (most common), thrombus, and compression of the blood vessel due to trauma or conditions like compartment syndrome.

Answer 43

A: are often referred to as the 6P's: Pain (severe and out of proportion) Paralysis (muscle weakness or even paralysis) Pallor (pale skin due to inadequate blood supply) Poikilothermal (inability to regulate skin temperature) Paresthesia (abnormal sensations due to nerve involvement) Pulseless (absence of pulse distal to the occlusion)

Answer 44

A: If a limb is considered viable, it means that there is no muscle weakness, minimal pain, no sensory loss, and positive Doppler pulses. Revascularization can potentially save the limb in this case.

Answer 45

A: If a limb is considered threatened, it means that immediate revascularization is required to prevent limb loss. Signs of weakness, pain, sensory loss, and absent or reduced Doppler pulses indicate a threatened limb.

Answer 46

A: If a limb is considered nonviable, it means that the tissue has already suffered irreversible damage. Signs include paralysis, absence of pain (due to nerve destruction), loss of sensations, and absent pulses in Doppler examination. In such cases, amputation may be necessary.

Answer 47

A: The ankle-brachial index (ABI) is a first-line diagnostic test for PAD. It involves comparing the blood pressure in the ankle to that in the brachial artery. A lower ABI indicates more severe PAD. Values ≤0.9 are diagnostic of PAD.

Answer 48

A: CT (computed tomography) or MRA (magnetic resonance angiography) is used in patients with acute limb ischemia or critical limb ischemia to assess candidacy for revascularization. Contrast is used to visualize the blood vessels and determine the extent of the occlusion.

Answer 49

A: Duplex ultrasound is a non-invasive alternative to CT/MRA. It is a simple bedside test that can be used when there are contraindications to contrast. It can show occlusions and increased velocities in the blood flow.

Answer 50

A: Digital subtraction angiography (DSA) is considered the gold standard for diagnosing PAD. It is an invasive procedure where a catheter is used to inject contrast, allowing real-time visualization of the blood vessels and identification of stenosis.

Answer 51

A: * is a differential diagnosis for PAD and is caused by spinal stenosis. * It results in exertional calf pain due to compression of nerve roots. * Differentiating features include postural low back pain (worsened by extension, relieved by flexion), * decreased or absent deep tendon reflexes (DTR), normal pulses or bruits, and normal skin findings (no thin skin, cold skin, thin nails, thin hair, ulcers, or gangrene).