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Surgery > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

Peripheral Vascular Disease

A

Lower extremity disease of reduced blood flow due to presence of atherosclerotic plaques

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2
Q

Cause of PVD

A

Atherosclerosis

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3
Q

RFs of PVD

A

Smoking (most important)
HTN
Hyperlipidemia
Diabetes

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4
Q

Claudication in LE PAD (3 sxs)

A

Leg pain with walking
Several minutes of rest alleviate pain
Pain is reproducible at the same walking distance & intensity

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5
Q

MC site of Peripheral Atherosclerosis

A

Superficial Femoral Artery
- Level of Adductor (Hunter’s) canal

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6
Q

Muscle group commonly affected by claudication in PAD

A

Calf muscle (supplied by SFA)

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7
Q

What arteries are artherosclerosed in Aortoiliac occlusive disease?

A
  • Infrarenal Aorta
  • Common iliac arteries
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8
Q

Triad for Aortoiliac Occlusive Disease

A
  1. Claudication of low back, buttocks, hip or thigh
  2. Absent or diminished femoral pulses
  3. Erectile dysfunction
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9
Q

CFs of LE PAD

A
  • Dry, shiny & scaly skin
  • Hairless
  • Brittle & thickened toenails
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10
Q

What symp. indicated severe PAD? (2)

A
  1. Ischemic rest pain
  2. Impending limb loss
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11
Q

Characteristic features of Ischemic rest pain

A

Nighttime forefoot or toe pain that awakens pts. from sleep
- Better by placing leg in dependent position and

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12
Q

Mechanism of ischemic rest pain

A

Laying in bed reduces gravity-assisted blood flow –> Ischemia

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13
Q

Beurger test (steps)

A

Observing foot perfusion w/ pt. in supine position:
1. Raising legs to 45 degrees for 1-2 mins –>
2. Placing leg in dependent position

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14
Q

+ve Beurger test (results & indication)

A
  1. Pallor on elevation
  2. Rubor in dependent position
  • Indicated severe PAD
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15
Q

Reason for Rubor during Beurger test

A

Compensatory arteriolar dilation & reactive hyperemia

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16
Q

Cause of Neurogenic claudication

A

Nerve root compression in the setting of Lumbar spinal stenosis

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17
Q

CFs of Neurogenic claudication

A

B/l & asymmetric- leg pain, sensory loss & weakness
Worse w/ walking & erect postures
Better w/ sitting, lying down & leaning forward

18
Q

CFs of Acute Lumbosacral Radiculopathy/ S1 Radiculopathy

A
  • Lower back pain
  • Radiates down posterior thigh into foot
  • Dec sensation in posterior thigh & lateral edge of foot
  • Loss of ankle reflex
19
Q

Test-of-choice for diagnosis of Arterial stenosis or Occlusion in setting of suspected PAD

A

Resting Ankle-Brachial Index (ABI)
- <0.4 –> Severe PAD (rest pain)
- 0.4 - 0.9 –> Moderate PAD (claudication)
- 0.91 - 1.3 –> Normal
- >1.3 –> Unreliable (incompressible vessel)

20
Q

Disease that are associated with ABI > 1.3

A
  • Diabetes Mellitus
  • ESRD

D/t Medial calcinosis

21
Q

Other Diagnostic test

A
  • Arterial duplex scans
  • CT angiogram
22
Q

Arterial Duplex scans

A

Ultrasound (identify a. plaques) + Doppler (detect elevated blood flow velocity –> stenosis is hemodynamically relevant)

  • Triphasic –> Normal
  • Biphasic –> Single-level / Moderate PAD
  • Monophasic –> Multi-level/ Severe PAD
23
Q

Gold standard for localizing areas of vessel stenosis

A

CT-angiography
- reserved for pts. planning to undergo invasive therapeutic interventions

24
Q

Management of Mild-to-Moderate PAD w/ claudication

A
  • Supervised exercise therapy ( inc. collateral circulation)
  • Smoking cessation
  • Antihypertensives
  • Statins
  • Antiplatelets (aspirin or Clopidogrel)
    *Dec Cardiovascular risk)
  • Cilostazol (PDE3 Inhibitor) - Improve walking distance in pts. w/ claudication refractory to lifestyle modification & medical therapies
25
Q

Mechanism of PDE3-Inhibitors

A
  • Inhibits platelet aggregation.
  • Promotes vasodilation
  • Inhibits smooth muscle cell proliferation
26
Q

Management of all pts. w/ PAD

A

Invasive revascularization
- Percutaneous transluminal angioplasty w/ or w/o stenting.
- Bypass grafting

  • Limb amputation (severely diseased)
27
Q

Acute LE Occlusion

A

Sudden onset of impaired perfusion that threatens limb viability

28
Q

CFs of Acute LE Occlusion (6 P’s)

A
  1. pulselessness
  2. Pain
  3. Pallor
  4. Poikilothermic (cold)
  5. Paresthesia
  6. Paralysis
29
Q

MCC of Acute LE Occlusion

A

CARDIAC EMBOLI
- A. fib (MC)
- Post MI
- Valvular disease
- Atrial myxoma
- CHF? Cardiomyopathy

  • L. atrium MC site of origin for emboli*
30
Q

MC location of Arterial embolization or Acute LE Occlusion

A

Common Femoral Artery Bifurcation –> Superficial Femoral A. + Profunda femoral A.

30
Q

How long does it take for complete cell damage to occur?

A

> 6 hours
- Severe limb impairment & maybe amputaion

30
Q

Imaging for ALEO

A
  • CT angiogram (gold standard)
  • Emergent open embolectomy (ballon or Fogarty catheter)
31
Q

Management of ALEO

A
  • Heparin
  • IVF
  • Placement of affected limb in dependent position
  • Even before imaging is done*
  • Mild occlusion –> Endovascular thrombolysis
  • Irreversible damage- Amputation
32
Q

MCC of Acute Arterial Limb Ischemia

A

Arterial embolism

33
Q

MC location of Acute Arterial Limb Ischemia

A

LE&raquo_space; UE

34
Q

MCC of arterial embolization

A
  • Atrial thrombi <– A. fib
  • Mural thrombus <– Recent MI
35
Q

How soon should reperfusion of limb w/ thrombolytic occur before muscles become necrotic?

A

Within 6 hours

36
Q

How should Heparin anticoagulation be given?

A

IV bolus followed by continuous Heparin drip
- 1st step of Tx

37
Q

How to prevent Compartment syndrome?

A

Fasciotomy

38
Q

Surgical procedure of choice for pts. w/ acute arterial limb ischemia

A

Fogarty ballon catheter embelectomy

Surgery (10 decks)

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