Peripheral Vascular Disease

Question 1

Greatest Atherosclerosis Risk Factors

Answer 1

Diabetes and smoking are greatest risk factors; diabetes is more significant

Question 2

Atherosclerosis Affected Areas

Answer 2

This is a systemic disease because affects all arteries in the body; don’t just focus on the part of the body the patient is complaining about

ATHEROSCLEROSIS: A systemic process affecting all vascular beds and the heart

Question 3

Pseudoclaudication vs. Intermittent Claudication

Answer 3

Pseudoclaudication: neurologic symptoms with it from impingement in spine; pain with standing, and variable onset

Intermittent Claudication: does not occur with standing, location of discomfort varies, onset is the same each time (distance)

Question 4

ABI

Answer 4

ABI = ankle systolic pressure / brachial systolic pressure

The lower the ABI, the higher the chance of death/ lower chance of survival
Super high ABI is abnormal (>1.3)

Question 5

Indication for Cilostazol

Answer 5

Cilostazol is indicated for the reduction of symptoms of intermittent claudication, as indicated by an increased walking distance
Used to tx claudication and nothing else

Question 6

Contraindications to Cilostazol Use

Answer 6

Congestive Heart Failure (CHF) of any severity
Any known or suspected hypersensitivity to any of its components

Cilostazol and several of its metabolites are inhibitors of phosphodiesterase III. Several drugs with this pharmacological effect have caused decreased survival compared to placebo in patients with class III-IV congestive heart failure. PLETAL is contraindicated in patients with congestive heart failure of any severity.

Question 7

Antiplatelet Therapy Use

Answer 7

All patients with peripheral arterial disease should receive antiplatelet therapy unless contraindicated!

Question 8

Acute Arterial Occlusion Ischemic Rest Pain Presentation

Answer 8

Presentation – the 4 “P”s
Pain
Pallor
Pulseless
Paresthesia

Question 9

Fibromuscular Dysplasia (FMD)

Answer 9

Congenital absence of medial layer of artery (muscular layer) which provides structure

Renal - 60 – 75% involved

20 – 50 year old female with HTN

Question 10

Raynaud’s Phenomenon

Answer 10

Triphasic color change
White – cessation of blood flow
Blue – as slow blood flow returns, majority desaturated blood.
Red – digital arteries fully open – reactive hyperemia – throbbing pain.

Question 11

Thromboangiitis ObliteransBuerger’s Disease

Answer 11

Treatment: total abstinence from all forms of tobacco

Question 12

Compartment Syndrome

Answer 12

Clinical situations:

Trauma – fractures
Malfitting bandages or casts
DVT – phlegmasia cerulea dolens
Arterial reperfusion injury – thrombolysis
Arterial sheath hematoma

Question 13

Recurrence of DVT

Answer 13

If patient had provoked DVT (from knee surgery for example) your risk of recurrence in one year is 1% and at 5 years is 3%

If from medical illness it is 5%, and 15%

If unprovoked, they have a higher risk of recurrence is 10% and 30%

Hypercoagulable states during pregnancy, and post birth 2 weeks is the highest risk of DVT

20 - 25% of patients die suddenly of DVT before getting treatment

Question 14

Deep Venous Thrombosis Spectrum: Risk for PE and Post-Thrombotic Syndrome

Answer 14

If DVT in tibial vein: low risk
If DVT in femoral-popliteal vein: medium risk
If DVT in iliofemoral: high risk

Question 15

Iliofemoral DVT Etiology

Answer 15

May-Thurner Syndrome
“iliac vein compression syndrome”
R common iliac artery crosses over L common iliac vein
Chronic compression cause inflammatory syndrome, get dehydrated
Surgical repair