Peripheral Vascular Disease Flashcards
PVD
Limb pain upon exertion is a symptom of PAD and is termed
intermittent claudication
PVD
PVD is also known as arteriosclerosis obliterans, is primarily the result of _______.
atherosclerosis
PVD
Peripheral Vascular Disease AKA
Peripheral Arterial Disease
or Peripheral Arterial Occlusive Disease
PVD
Up to ___ million people affected in US
12
PVD
___% of people over 55 suffer from PVD
10% - 25%
PVD
Despite PVD prevalence and complications, only ___% of those affected are receiving treatment.
25
PVD
Pt with PVD have ____ times increased risk of stroke and MI
4-5
PVD
______ increases the risk of atherosclerosis by approximately threefold
smoking
PVD
adults over ___ are at increased risk of PAD
55
PVD
PAD more frequent in older adults, with a ___ to ____ increase in risk for every 10-year increase in age
1.5 to twofold
PVD
PVD Risk Factors
- >55 (2x)
- Smoker, 20 pack year (2-3x)
- DM (3x)
- Dyslipidemia
- Hypertension (>130)
- A-fib (medical emergency)
PVD
other pathologies for developig PVD include
- Autoimmune disease (RA)
- Systematic Lupus
- Malar (BuLerfly) rash on face
- Trauma, surgery
PVD
when do symptoms of PVD start?
70% occlusion
PVD
developement of occlusion (atheroma) can start as early as
the teen years
PVD
the atheroma (occlusion) is made of
a chore of cholesterol (fat) joined to proteins
PVD
90% of occlusion =
pain at rest
(night pain)
PVD
what happens when te plaque within an artery ruptures?
platelets aggregation at the site → form a clot (thrombus) that further occludes the vessel
PVD
thromboses occur more in the _________ extremities than in the _______ extremities
lower > upper
PVD
PVD manifest more acutely when
thrombi, emboli, or acute trauma compromises perfussion
(A-fib?)
PVD
the most common cause of sudden ischemia
emboli
(can be of cardiac origin 80%, or from proximal atheroma)
PVD
`emboli tend to lodge at artery bifurcations.
Which artery is the most common site of emboli lodge?
femoral artery, then iliac artery, then aorta, and the popliteal arteries
PVD
emboli tend to carry higher comorbidity because
the extremity has not had the time to develop collateral circulation
PVD
symptoms/signs of PVD; acute limb ischemia
- Pain (ischemic pain is the worse pain)
- Paresthesias (numbness)
- Poikilothermia (cold)
- Pallor
- Paralysis
- Pulseless
PVD
most common manifestation of PVD
claudication (ischemic pain with exercice)
PVD
aortoiliac disease manifest as pain in
the thigh and buttock
PVD
with popliteal occlusion, the ischemic pain will be at
the foot
PVD
femoral-popliteal disease manifests as pain in ____
calf
(most typical type of pain)
PVD
true or false: claudication may also present as the hip or leg “giving out” after a certain period of exertion and may not demonstrate the typical symptoms of pain on exertion
true
PVD
Distal extremity color change with position is a sign of PVD. Skin rubor when leg dependent. Skin pallor when leg elevated > 1-minute. If color takes more than 40 seconds to return it means…
severe ischemia
PVD
Skin signs of PVD
- Cold to touch
- Dry, scaly, shiny atrophic skin
- Hairless over lower extremity
- Dystrophic toenails
- Non-healing ulcers
PVD
An ankle-brachial ratio of > 0.95 - 1.2
normal
PVD
An ankle-brachial ratio of < 0.95
Peripheral Vascular Disease
PVD
An ankle-brachial ratio of < 0.6
Intermittent Claudication
PVD
An ankle-brachial ratio of < 0.26
Resting Ischemic Pain
PVD
An ankle-brachial ratio of < 0.2
Gangrenous Extremity
PVD
an excellent noninvasive confirmatory test of PVD
Duplex Arterial US
PVD
Check Pulses, skin → ABI → Duplex Arterial US →
angiogram (gold standard)
PVD
criterion standard for diagnosis of PVD
Angiogram
PVD
PVD mgmt
- Smoke cessation
- Cholesterol mgmt
- Hypertension mgmt
- Exercise program
PVD
Exercise dosage in PVD that has been shown to increase pain-free walking by 179% and max walking time by 122%
- start with 3-5 sessions/week for 30 min per time
- Increase by 5 min until 50-60 min.
- 30-45 minutes
- minimum 12 weeks
- Continue indefinetly
PVD
medication mgmt of PVD
- Aspirin
- Coumadin
- heparin
PVD
Cilostazol, also know as Pletal is a medication used in the
alleviation of intermittent claudication in individuals with PVD
PVD
surgical mgmt of PVD (when 90% occlusion has been achieved)
- Angioplasty (catheter with dye, ballon/stent inserted)
- Vascular bypass
PVD
complications of PVD
gangrene
amputations
