Peripheral Vascular Disease Flashcards
How is blood flow to the extremities affected by
peripheral vascular disease?
Blood flow is compromised to the extremities.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 169.
ame the most common cause of impaired blood
flow to the lower extremities.
Atherosclerosis
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 561.
List the most common risk factors associated with
the development of atherosclerosis.
Cigarette smoking, hypertension, elevated triglycerides,
sedentary lifestyle, impaired long-term glucose regulation,
hypercholesterolemia, obesity, male gender, genetic
predisposition, c-reactive protein, hyperhomocysteinemia.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 562.
Why are patients with peripheral vascular disease of
the lower extremities at an increased risk for cardiac
ischemia?
Patients with peripheral vascular disease often have associated
cerebrovascular and coronary artery disease.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 169.
What are the two main symptoms of peripheral
vascular disease? Why do these symptoms occur?
Rest pain and intermittent claudication. Rest pain is due to
arterial blood supply being less than the nutritional requirement
of the extremity affected. Intermittent claudication is the result of
oxygen delivery to exercising skeletal muscles being less than
the metabolic requirement of those muscles.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 169.
What is the most reliable finding on physical
examination associated with peripheral vascular
disease?
Absent or diminished arterial pulses.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 169.
List the signs of chronic leg ischemia.
Hair loss, pallor, coolness, subcutaneous atrophy, dependent
rubor, and cyanosis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 169.
What is the ankle-brachial index? What value is
indicative of the presence of peripheral vascular
disease?
The ankle-brachial index is the ratio of the systolic blood
pressure measured by doppler ultrasonography at the ankle to
the brachial artery systolic blood pressure. This index is used
as a tool to quantitatively assess for the presence and degree of
peripheral arterial stenosis. An ankle-brachial index less than
0.90 is indicative of the presence of peripheral vascular disease.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 169.
What is atherosclerosis?
Atheroclerosis is a degenerative disease that leads to the
formation of plaques that can obstruct the lumen of a blood
vessel and reduce distal blood flow. In addition to stenosis
caused by placque formation, acute ischemia from thrombosis,
embolism, and the formation of aneurysms occur in the
pathophysiologic process.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 561.
What diagnostic tool is used to identify blood vessels
with stenotic lesions?
Doppler ultrasonography
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 169.
What patient populations necessitate
revascularization procedures?
Patients with ischemic rest pain, claudication that is disabling,
and those facing potential limb loss require revascularization
procedures.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 170.
What are the two methods in which revascularization
is achieved?
Surgical reconstruction and endovascular interventions.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 170.
What is the main intraoperative risk to a patient
undergoing reconstructive peripheral vascular
surgery
Myocardial ischemia
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 171.
For patients unable to preoperatively undergo an
exercise stress test due to claudication, what
diagnostic tools can be used to identify the presence
of ischemic heart disease?
Nuclear imaging and pharmacologic stress tests (with or without
the use of echocardiography).
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 170.
According to the American College of
Cardiology/American Heart Association, what three
patient populations are appropriate candidates for
perioperative beta blocker therapy?
- Patients who have received beta blocker therapy long-term.
- Patients presenting for vascular surgery with or without the
presence of intermediate or high risk factors and with or without
the evidence of ischemia preoperatively. 3. Patients presenting
for vascular surgery with low risk factors.
Stoelting RK, Hillier SC. Pharmacology and Physiology in
Anesthetic Practice. Philadelphia, PA: Lippincott Williams and
Wilkins; 2006: 147.
