Peripheral Vascular Disease Flashcards
full-thickness dilation of the abdominal aortic artery to 1.5 times the diameter measured at the level of the renal arteries
abdominal aortic aneurysm (AAA)
what diameter of the abdominal aorta considered aneurysmal?
3cm or more
what population is affected by AAA? (2)
men
smokers
caucasians
mortality from AAA rupture is ____ to ____%
70-95%
what is the most commonly used predictor for AAA rupture?
maximum diameter of AAA
where do AAA tend to develop?
infrarenal aorta
5-yr rupture rate of asymptomatic AAA is ___ to ___% for aneurysms over 5cm in diameter
25-40%
5-yr rupture rate of asymptomatic AAA is ___ to ___ for AAA 4-5cm
1-7%
screening for AAA via ultrasound is recommended for who? (2)
men 65-75 yrs + smoking hx
over 60 yrs + fam hx of AAA
what is the monitoring rule for a patient with a AAA measuring 4-5.4 cm?
ultrasound or CT every 6-12 months
what is the monitoring rule for a patient with a AAA that is less than 4cm?
ultrasound every 2 years
a patient presents with abdominal, back, flank/groin pain + early satiety, nausea, and vomiting with compression of bowel. what are they likely experiencing?
AAA
what are 3 diagnostics that can be used for a AAA?
abdominal ultrasound
CT scan
MRA
what may indicate a thrombus within the anuerysm?
elevated D-dimer
what is the main medical treatment for AAA?
antibiotics (doxy + roxithromycin)
when can a beta blocker be used to treat AAA?
AAA + marfan’s syndrome
what are 2 surgical treatments for AAA?
endovascular aneurysm repair
open repair
blood passing through an intimal tear, separating the intima from the medial layers and creating a false lumen; intramural hematoma leads to this…
aortic dissection
what are 3 risk factors for aortic dissection?
hypertension
atherosclerosis
age
a patient presents with sudden onset of severe sharp/tearing/ripping chest pain and syncope. what are they likely experiencing?
aortic dissection
anterior chest pain is indicative of what kind of aortic dissection?
ascending dissection
back and abdominal pain is indicative of what kind of aortic dissection?
descending dissection
what are 4 diagnostics that can be used for an aortic dissection?
transesophageal echo
CTA
MRI
multidetector CT
what is the acute general treatment for an aortic dissection?
pain control
lower BP with IV beta blockers (CCB if BB contraindicated)
inhibition of blood flow to the lower extremities
peripheral artery disease
what are the 2 main causes of PAD?
atherosclerotic disease
plaque formation
what are 4 risk factors of PAD?
smoking
diabetes
hypertension
hypercholesterolemia
a patient presents with claudication of the calf/thigh/buttock, bruits, changes in skin color, and prolonged capillary refill. what are they likely experiencing?
PAD
what is a sign of a more serious case of PAD?
aching/burning of toes and feet
what are the essential parts of a physical for a patient with suspected PAD? (4)
BP in both arms - note symmetry
palpate pulses
bruits
inspect extremities
the highest resting systolic BP at the ankle is compared with the highest systolic brachial pressure, and the ratio of the two pressures give us this number
ankle-brachial index (ABI)
what should be performed to establish diagnosis of lower extremity PAD in patients
ankle-branchial index
what are 3 diagnostics used for PAD?
CTA
MRA
Ultrasound
what diagnostic is used for patients with PAD who are being considered for revascularization?
contrast angio
what are 2 therapies indicated to treat PAD?
antiplatelet therapy (ASA or clopidogrel)
ramipril (for HTN)
what medication can be used for PAD to increase pain-free walking and ABI?
pletal (cilostazol)
inflammation of medium and large arteries on the side of the head
giant cell arteritis
a patient presents with scalp tenderness, fever, weight loss, stiff trunk, visual loss, and claudication of the jaw and tongue on mastication. what are they likely experiencing?
giant cell arteritis
what diagnostic is used for giant cell arteritis?
temporal artery biopsy
what is the treatment for giant cell arteritis? (2)
IV methylprednisolone
oral prednisone
what are 3 main causes of a DVT?
prolonged immobilization (>3 days)
postoperative state
trauma to LE/pelvis
what are 3 differentials of a DVT?
cellulitis
lymphangitis
achilles tendinitis
what is the presentation of a patient with a DVT?
pain/swelling of extremity
leg pain on dorsiflexion of the foot (homan sign)
what is the diagnostic test of choice for a DVT?
compression ultrasound with doppler
what lab can be useful to check for a DVT?
d-dimer (sensitive - SNOUT)
what medications can be used to treat a DTV? (4)
heparin
enoxaparin
fondaparinux
warfarin
what can reduce the incidence of post-thrombotic syndrome in a DVT?
compression stockings
what treatment can be used for a DVT if a patient cannot have anticoagulants?
IVC filter
what should be considered in all patients with unprovoked and frequent venous thromboembolisms?
cancer
a patient presents with varicose eczema, hyperpigmentation, atrophie blanche, and lipodermatosclerosis. what are they likely experiencing?
chronic venous insufficiency (CVI)
the most common and earliest sign of CVI that consists of pruritic, red, and scaly patches above the medial ankle
varicose eczema
a sign of CVI caused by the breakdown of RBCs and leads to hemosiderin deposition
hyperpigmentation
sign of CVI that are hypopigmented white patches with focal red punctate dots or telangiectasia surrounded by hyperpigmentation
atrophie blanche
sign of CVI that is chronic, brawny induration of the skin, leading to inverted champagne bottle appearance of the leg; susceptible to ulcers
lipodermatosclerosis
what diagnostic is used for CVI to identify reflux in the superficial, deep, and perforating veins + obstruction of the deep veins
duplex ultrasound
what are some nonpharmacological treatments for CVI? (2)
leg elevation for 30mins 3-4x/day
compression stockings
what is the medical treatment for CVI?
topical corticosteroids for inflammation + itching
superficial venous insufficiency when venous return is impaired by valvular incompetence, obstruction, or calf muscle pump failure
varicose veins
a patient presents with aching, heaviness, swelling, cramps, itchiness, tingling and pain of the lower extremities. what could they be experiencing?
varicose veins
what are 2 complications of varicose veins?
SVT
bleeding
what diagnostic can be used for varicose veins if a patient wants more than conservative therapy?
duplex ultrasound
what is the treatment for varicose veins? (3)
aerobic exercise 30min/day
elevate legs
flex ankles
inflammation of a superficial vein
SVT
which vein is most commonly involved in SVT?
great saphenous vein
what is the most common cause of upper extremity SVT?
IV catheters and IV drugs
a patient has a tender cord or wormlike mass on their leg with increased warmth and erythema. what could it be?
SVT
what diagnostic can confirm an SVT?
duplex ultrasound
what is the treatment for an SVT? (2)
warm, moist compress
mobilization/exercise
what medication can be used for a LE SVT within 1cm of the saphenofemoral or saphenopopliteal junction?
fondaparinux
