PERIPHERAL VASCULAR DISEASE

Question 1

peripheral vascular disease: definition & causes

Answer 1

compromised blood flow to the extremities (ankle/branchial index of <0.9; normal is .95)

causes

• atherosclerosis MOST COMMON (aka also assume CAD)
• arterial embolism
• vasculitis

Question 2

risk factors of atherosclerosis

Answer 2

AGE, MALES

DM
obesity, sedentary
HTN
smoking
dyslipidemia
fam hx

Question 3

PVD s/s

Answer 3

Most common = intermittent claudication “angina of the legs” (stops w/ rest)

Others =

• cold feet
• pain when supine, relieved upright
• loss of pulses in legs/feet, pale color when legs are raised
• dependent rubor
• shiny skin, loss of hair
• thickened toenails

Most severe = critical limb ischemia (“rest pain”) - lack of O2 to limb/leg at rest = associated w/ nonhealing ulcers & gangrene

Question 4

ankle/brachial index

Answer 4

ratio of ankle SBP to brachial SBP

normal = .95 at rest
claudication =

Question 5

tx of PVD

Answer 5

• ID/tx risk factors (exercise, lifestyle changes, weight loss, smoking cessation)
• statins
• vitamin C, E, folate supps
• antiplatelet therapy
• revascularization procedures
• amputation

Question 6

peripheral revascularization surgery (approach)

Answer 6

1. expose donor & recipient arteries
2. create tunnel, pass graft
   (graft is saphenous vein or prosthesis)
3. give IV heparin
4. construct anastomosis
5. arteriogram to confirm flow

Question 7

anesthetic considerations w/ PVD

Answer 7

• principle risk during reconstructive surgery is associated w/ atherosclerosis, esp. ischemic heart dz
• PVD pt has 3-5x greater risk of MI, CVA, death
• CABG before peripheral vasculature procedures if both are warranted

Question 8

advantages of regional anesthesia for peripheral revascularization

Answer 8

1. increased graft flow
2. less increase in SVR w/ cross clamping
3. postop px relief
4. less activation of coag cascade

• *heparin will be administered
• *consider pt’s comorbidities