Peripheral vascular disease Flashcards
Name arterial occlusive arterial conditions (one is acute and one is chronic)
Acute: dissecting aneurysm
Chronic: microangiopathy
Name two functions arterial peripheral vascular diseases:
Raynauds (vasoconstriction)
Erythromelangia- vasodilation
What category of PVD does mess redux thrombosis and AV fistula fall into?
Mixed
Name the two types of venous PVD
Venous thrombosis and varicose veins
What is the number one cause of PVD? What are other causes?
Atherosclerosis #1
Marfans
Vascular inflammation (RA, Kawasaki, Lupus)
Thrombosis (coagulopathies)
Vasospastic Dx
What are risk factors for PVD
Smoking DM HTN HLD C-reactive protein
When should you start screening for PVD?
Age 65
What is pseudoclaudication?
Pain when walking or standing that doesn’t become relieved when standing still but is relieved with change of position.
It indicates lumber stenosis
What does the Ankle-brachial index test for?
Peripheral arterial disease
If you suspect that a patient has PAD but their resting ABI is normal what do you do next?
Exercise ABI
What are the ranges for ABI?
> 1.30= non compressible (do US and toe pressure may be PAD)
- 91-1.30 normal no PAD
- 41-0.90 mild to moderate PAD
What test do you order if a patient is suspected to have PAD but is a symptomatic?
ABI
What test do you order if a patient has possible pseudoclaudication?
Exercise Test
What test do you order if a patient has claudication?
ABI, PVR, duplex US, exercise test
What test do you order if a patient has a suspected AAA?
US, CTA, MRA
What 5 instances would you be concerned with contrast?
CKD, Adam, Dehydation, NSAIDS, CHF
What are the four steps in treating claudication?
- Smoking cessation
2 Meds- lipid meds, BP meds, Pletal, diabetes meds, and ASA or Plavix - Exercise rehabilitation
- Revascularization
What is the grading system for pallor?
0- no pallor is 60 seconds 1- 2- 3- 4- pallor without elevation
What are symptoms of PAD?
Ulcers Hairless legs Shiny skin Pallor on elevation Ruddy on dependancy Pain with elevation Claudication Thick toenails Calf atrophy
What are the 6 P’s of PAD?
- Pain
- Pallor
- paresthesia
- Pulslessness
- Paralysis
- Polar (poikelothermia)
What are symptoms of PVD?
Non healing ulcers Varicose or tortuous veins Ruddy legs Heavy legs Itching Pain improved with elevation
What is the most common form of aneurysm?
AAA
Why is surgery needed for a AAA?
For larger than 5cm or rapidly growing
What are signs of a AAA?
A pulsating abdominal mass
Bruit
If impending rupture: back pain
Get US or CTA
Treatment for a Type B or Type 3 is what?
BP control with BB
Routine f/u
Control lipids
Smoking cessation
Ascending Thoracic Aneurysms are commonly caused by what?
Morgan’s (operate early)
Atherosclerosis
Family hx
Except margins sx for > 5cm
Descending thoracic aneurysm is treated how?
Meds, surgery only if necessary due to high risk of spinal cord ischemia
Popliteal aneurysm is operable at what size?
2cm
What is the Sanford classification system of aortic dissection?
A- ascending aorta or proximal (can extend beyond the aortic arch)
A surgical emergency
B- descending or distal: medical treatment
What are three things that can be caused by a Type A aortic dissection?
Cardiac Tamponade, MI, Aortic Regurg.
What is the debakey classification system?
Type 1- extends beyond the aortic arch abs beyond it distal
Type 2- ascending aorta only
Type 3- descending aorta
What are symptoms of aortic dissection?
- Chest pain
- Impending doom
- Tearing feeling
- Syncope
- Lower extremity paralysis
- Aortic regurg ( in ascending)
Medical management doe Type B (or 3) is what?
Lower BP- systolic 100-120
Control HR- BB best
Labetolol, esmolol, metoprolol
Then nitroprusside (not first choice cause can increase HR)
If a patient is suspected of RAS what tests might you run?
US, MRA, Angiography
What are treatments for Raynauds?
Warmth and protection Hand lotion ASA CCB Stress management
What might you suspect if a elderly patient comes in with a fever of unknown origin, abdominal pain?
Mesenteric ischemia
Where do most mesenteric artery emboli come from?
Left ventricle
Mesenteric venous emboli are more common in who?
Women in pregnancy, estrogen therapy, malignancy, hypercoagulopathy
What tests would you order for mesenteric ischemia?
CBC, BMP, Coags, LFT, Amylase, Lipase, CKMM, Phosphate, Lactate
Angiogram is the gold standard for imaging
Note: phosphate and lactate elevating may be the first clue of infarction IVF ABX Avoid pressers IR or sx
What would you order for a DVT?
US, venous Doppler, venography
What medication would you prescribe for a DVT?
Lovenox- 1mg/kg SQ Q12 if creatinine clearance 2x normal
When should catheter directed TPA be administered?
If it’s an extensive DVT but the patient has good functional status
When should a filter be placed?
Only if anticoagulant must be discontinued due to bleeding risk
Or
The patient develops a DVT on anticoagulant
What testing should you order for a PE?
CXR DDimer VQ scan CTA D unstable then US
