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Medicine 1 > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

Susceptibility of stroke in the circle of willis

A

if on e of these vessels closes, there is enough vascular supply to maybe get away with not having a stroke

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2
Q

Most common access point (artery)

A
  • common femoral
  • usually right over the femoral head
  • if you have any bleeding in the leg, a good place to stop it is over the femoral head
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3
Q

veins important in the development of varicose veins

A
  • saphenous

- if they become dysfunctional, they can result in chronic venous insufficiency

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4
Q

most common cause of PAD

A

atherosclerosis

  • coronary disease present in >50%
  • mortality 2-3x greater vs general population
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5
Q

prevalence of PAD

A

3% 40-59yo
8% 60-69yo
19% >70yo

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6
Q

claudication vs pseudoclaudication

A
  • claudication = pain in the calf or hip with walking that is relieved with rest
  • pseudoclaudication = relieved when you have some support (i.e. resting on a shopping cart) whereas claudication is not
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7
Q

venous insufficiency stats

A
  • 2x more prevalent than coronary heart disease and sx more prevalent than PAD
  • 25 million have symptomatic reflux
  • 5% seek treatment annually
  • 2/3 of patients who seek treatment have saphenous reflux
  • 72% of women and 42% of men will experience varicose veins by the time they reach their 60s
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8
Q

clinical issues from venous insufficiency

A

pain, swelling, varicose veins, skin changes, ulcers

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9
Q

pathophysiology of venous insufficiency

A
  • normal veins have valves that open and close to assist return of blood to the heart
  • in venous insufficiency, valves become damaged or diseased
  • result of over-dilation of the venous vessels resulting in reflux
  • in some cases, can also be caused by damaged or absent valves
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10
Q

how to assess if venous reflux is present

A

duplex ultrasound scan

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11
Q

risk factors for PAD

A
  • Diabetes
  • Smoking
  • Hx of CAD
  • Elevated cholesterol or decreased HDL
  • HTN
  • Sedentary
  • Obesity
  • male gender
  • Age
  • Recently, increased plasma homocysteine was recognized as maybe being important in pathogenesis of atherosclerosis
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12
Q

Risk factors of venous insufficiency

A
  • Gender (women:men = 4:1; hormones may be a factor)
  • Age
  • Family hx
  • Pregnancy
  • Standing occupation
  • Obesity
  • Prior trauma or surgery
  • Sedentary lifestyle/prolonged sitting
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13
Q

Sxs of venous insufficiency

A
  • leg pain, aching, or cramping
  • burning or itching of the skin
  • leg or ankle swelling
  • “heavy” feeling in legs
  • skin discoloration or texture changes
  • open wounds or sores
  • restless legs
  • varicose veins
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14
Q

atypical symptoms of PAD

A
  • pain in the ankle with walking
  • rest pain may manifest in only one toe
  • back, hip and leg sxs in patients with chronic disc disease
  • “fatigue in the calf” with walking
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15
Q

PAD: inspection

A

skin color, hair loss, skin necrosis or ulceration, edema, bulging veins

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16
Q

PAD: palpation

A
  • feel for all pulses and grade them

- carotid, brachial, radial, ulnar, femoral, popliteal, dorsalis pedis, and posterior tibial

17
Q

arterial insufficiency ulcer

A
  • aka ischemic ulcer

- dry and painful

18
Q

venous stasis ulcer

A

-wet and painless

19
Q

PAD: auscultation

A
  • listen for carotid and femoral bruits

- abdominal bruits may indicate renal or mesenteric vascular stenosis

20
Q

How to perform and calculate Ankle-Brachial Index

A
  • detects arterial disease of the lower extremities
  • patient restins supine 5-10 mins
  • continuous wave, hand-held doppler
  • measure systolic BP in both arms - the higher value is the DENOMINATOR of ABI
  • measure systolic BP in DP and PT - the higher value is the NUMERATOR of ABI
  • if there is a discrepancy between arms and the guy is old, you need to worry about subclavian stenosis
21
Q

ABI values

A
  • ratio >0.9 –> normal
  • = 0.9 - >0.4 –> mild to moderate disease
  • = 0.4 –> severe disease
  • index is not always predictive of severity of sxs
  • DOES NOT DETERMINE WHETHER THE PROCESS IS A STENOSIS OR OCCLUSION
22
Q

diagnostic tests

A
  • duplex ultrasound
  • magnetic resonance angiography
  • spiral CT scanning with contrast
23
Q

duplex ultrasound

A
  • combines ultrasound and doppler velocity measurement with color flow
  • non invasive
  • technologist dependent
  • exercise testing
24
Q

common place for clots to form

A

popliteal artery

25
Q

digital subtraction angiography

A
  • GOLD STANDARD FOR ANY ENDOVASCULAR INTERVENTION OR SURGERY
  • invasive, requires intra-arterial access
  • need iodinated contrast
  • alternatives to contrast include carbon dioxide and gadolinium
26
Q

why use radial artery

A
  • provides nice access to the heart
  • can stent coronary arteries etc. through the radial
  • offers more safety than the femoral because there are two main arteries that supply the forearm (the femoral is the only one for the leg)
27
Q

exercise training

A
  • builds collaterals

- if you demand more blood flow, the blood vessels will work better

28
Q

risk factor modification

A
  • smoking cessation
  • lipid lowering therapy
  • diabetes control
  • weight loss
  • BP control
29
Q

Drug therapy options

A
  • cilostozol - improve walking distance (avoid in pts with poor LV function)
  • Clopidogrel, efficen, or Brilinta - antiplatelet drugs
  • statins - lipid lowering
30
Q

treatment of venous disease

A
  • compression stockings
  • diuretics, weight loss
  • wound care
  • surgical stripping
  • percutaneous ablation techniques
31
Q

Main limitations of ABI

A
  • calcified ankle vessels result in artificially “normal” ABI (DM, RF)
  • normal ABI in patient with aortoiliac disease - only becomes abnormal with exercise testing
32
Q

classification of PAD - Fontain’s stages vs Rutherford’s categories

A

Fontaine:

1: asymptomatic
2a: mild claudication
2b: moderate to severe claudication
3: ischemic rest pain
4: ulceration or gangrene

Rutherford:

0: asymptomatic
1: mild claudication
2: moderate claudication
3: severe claudication
4: ischemic rest pain
5: minor tissue loss
6: major tissue loss

33
Q

endovascular intervention

A
  • balloon angioplasty
  • self-expanding and balloon-expandable stents
  • atherectomy
  • laser
  • cryoplasty
  • mechanical thrombectomy
  • intraarterial thrombolytic therapy
  • stent grafts
  • aneurysm coiling/vascular embolization
34
Q

Chronology of catheter-based device therapy

A
  • 70-80s: balloon angioplasty
  • 80-90s: directional atherectomy, variety of lasers (thermal, excimer, etc.)
  • 90s-now: the stent era

Medicine 1 (8 decks)

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