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X Clin Med Final > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

What is the most common underlying cause of peripheral arterial disease?

A

Atherosclerosis (narrowing of arterial lumen that reduces blood flow to limb)

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2
Q

What is the progression of peripheral arterial disease?

A

Asymptomatic stenosis
Chronic arterial insufficiency
Limb-threatening ischemia (can be sudden tho)

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3
Q

What is important to know about PAD and mortality?

A

PAD is a powerful, independent predictor of mortality

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4
Q

What are fatty streaks in atherosclerosis?

A

Thickened intima and accumulation of foam cells

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5
Q

Where do plaques commonly occur?

A

Bifurcations: aortic, iliac, femoral

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6
Q

Important risk factors for atherosclerosis/PAD

A

Hypertension, diabetes, dyslipidemia/hyperlipidemia, smoking

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7
Q

Acute vs chronic limb ischemia

A

Acute: sudden decrease in limb perfusion, potential threat to limb viability
Chronic: pts who present later than 2 wks after onset of acute event

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8
Q

Where do most pts with PAD have athersclerosis?

A

Lower extremity

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9
Q

Groups at risk for PAD

A

Over 70
50-69 with hx of smoking/diabetes
40-49 with diabetes and one other risk factor for atherosclerosis
Leg sxs: claudication or ischemia pain at rest
Known atherosclerosis at other sites

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10
Q

Diabetes and amputation

A

Dose-response relationship between HgbA1c level and risk of amputation

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11
Q

What is claudication?

A 
Intermittent discomfort (cramps,aches) in defined muscle group, induced by exercise and relieved with rest
Calf, thigh or buttock
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12
Q

What is Leriche syndrome?

A

Claudication (buttock, hip, thigh)
Absent/diminished femoral pulses
ED

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13
Q 
What is the site of stenosis for each claudication sx?
Buttock/hip
Thigh
Upper 2/3 calf
Lower 1/3 calf
Foot
A 
Aortoiliac disease (Leriche)
Aortoiliac disease/common femoral artery
Superficial femoral artery
Popliteal artery
Tibial or peroneal artery
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14
Q

What is critical limb ischemia?

A

When blood flow is insufficient to meet demands at rest
Threatened limb!
73-95% limb loss or death at one yr without tx
Time sensitive!!!

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15
Q

Presentation of critical limb ischemia

A

Ischemia rest pain: pain in forefoot/toes aggravated by elevation and relieved by dependency
Non-healing wounds/ulcers
Skin discoloration/gangrene (pale elevated and red lower)

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16
Q

What is the ankle-brachial index?

A

Ratio of ankle SBP divided by highest brachial SBP

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17
Q

When do you perform the ankle brachial index?

A

Lower extremity exertional sxs
Risk factors for PAD
ABI

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18
Q

What is an arterial duplex doppler ultrasound?

A

Reflected sound wave frequency is used to determine velocity of blood flow
Can find the site and severity of vascular obstruction (% stenosis)

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19
Q

What is the gold standard for diagnosis of PAD?

A

Vascular imaging: contrast arteriography (angiogram)

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20
Q

What are the lifestyle modifications and risk factor reductions for PAD?

A 
Antiplatelet therapy (ASA or Plavix)
Smoking cessation
Lipid lowering therapy (moderate dose statin)
Control blood sugar and BP
Weight management
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21
Q

Tx for claudication sxs of PAD

A 
Supervised exercise (30-45 min 3xwk for 12 wks)
Cilostazol (Pletal): phosphdiestase inhibitor, antiplatelet and vasodilator effects
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22
Q

What is the first line tx for revascularization of PAD?

A

Endovascular in critical limb ischemia

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23
Q

What are the endovascular interventional procedures?

A

Percutaneous transluminal angioplasty, stents, atherectomy

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24
Q

Most common bypass graft

A

Femoral-popliteal

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25
Q

What is the most common cause of acute arterial occlusion?

A

Thromboembolism (majority originate in heart)

Others (sudden thrombotic occlusion of narrowed segment, atheroembolic debris, arterial dissection)

26
Q

Sxs of acute arterial occlusion

A 
6 Ps (usually in this order too)
Paresthesia
Pain (located distal and progress proximal)
Pallor
Pulselessness
Poikilothermia
Paralysis
27
Q

Management of acute arterial occlusion

A 
Emergency surgical consult
Anticoagulation with heparin
Thrombolytics- intrarterial
Thromectomy/ embolectomy
Surgical bypass
Amputation in 25-30%
28
Q

Most common things seen chronic venous disease

A

Telangiectasias, varicose veins, chronic venous insufficiency
Higher in women than men

29
Q

What causes chronic venous disease?

A

Venous hypertension (dysfunction of venous valves, obstruction to venous flow, failure of venous pump)

30
Q

What veins are affected in chronic venous disease?

A

Usually superficial ones

31
Q

Main presentation of chronic venous disease

A

May be asymptomatic but aching. heaviness or burning sensation that is worse with standing and relieved by elevation

32
Q

What causes chronic venous insufficiency?

A

Valvular incompetence or result of DVT with residual damage to vein (recanalization after DVT)
Rigid and thick-walled veins

33
Q

What are more advanced clinical signs of chronic venous insufficiency?

A

Significant edema, skin changes, ulcerations

34
Q

What is hemosiderin staining?

A

Seen in chronic venous insufficiency

Pigmented byproduct of Hb

35
Q

What is lipodermatosclerosis

A

Seen in chronic venous insufficiency
Inflammation of layer of fat under epidermis, subQ fibrosis and hardening of skin
Looks like champagne bottle

36
Q

What can you find with venous duplex dopple u/s?

A

Valve insufficiency, chronic vein wall thickening, chronic thrombosis

37
Q

What is the gold standard to diagnose chronic venous insufficiency?

A

Venography

38
Q

What do you see in stasis dermatitis?

A

Erythema, inflammation, pruritus, scaling and vesicle formation (mostly medial ankle)
Use emollients, barrier creams or topical corticosteroid

39
Q

Management of chronic venous disease

A

Exercise, weight loss, mechanical, compression therapy, wound care
Meds (diuretics for edema, abx), radiofrequency or lase, sclerotherapy for small surface veins, vein stripping or skin grafts

40
Q

When is compression therapy contraindicated?

A

Moderate to severe PAD, cellulitis and acute DVT

41
Q

What is the most common cause of aortic aneurysms?

A

Atherosclerosis

Also connective tissue disease (marfans, ehlers-danlos), infection, trauma

42
Q

Common presentation of aortic disease

A

Severe, persistent chest pain, syncope, CVA-like sxs, altered mental status, paresthesia
Hypertensive usually, dimished or unequal peripheral pulses, horner’s syndrome

43
Q

Test of choice for dx of aortic dissection

A

CT chest and abdomen (CXR can be used to show widened mediastinum but not test of choice)

44
Q

First line treatment of aortic dissection

A

True emergency! Immediate control of BP with beta-blockers (labetalol)

45
Q

Most common sxs of thoracic aortic aneurysm

A

Most are asymptomatic

May have back pain, dysnpea, stridor, edema in neck and arms, distended neck veins, hoarseness

46
Q

Diagnostic test of choice for thoracic aortic aneurysm

A

CT scan (ONLY IF STABLE)

47
Q

Most common site of abdominal aortic aneurysm

A

Infrarenal abdominal aorta

48
Q

What can an AAA lead to?

A

Rupture or dissection, thromboembolism, compromised renal blood flow

49
Q

When can you feel the AAA in 80% of pts?

A

Over 5 cm

50
Q

Sxs of abdominal aortic rupture

A

Excruciating abdominal pain that radiates to back, pulsatile mass, tenderness, hypotension

51
Q

What is the diagnostic study of choice for screening of AAA?

A

Abdominal u/s

CT scan is more reliable tho and should be used when the diameter is closer to 5.5 cm

52
Q

What is the age you look at for screening for AAA?

A

65-75 (all current or past smokers or have relative with AAA)

53
Q

Management of AAA

A

Risk factor modification, watchful waiting (routine u/s), refer to vascular specialist

54
Q

What types of repair can you do for AAA?

A

Endovascular repair or open surgical resection

55
Q

Sxs of carotid artery stenosis

A

TIAs
Focal neuro sxs (amaurosis fugax which is transient monocular blindness or contralateral weakness/numbness, dysarthria or aphasia)

56
Q

What might you see on a PE in carotid artery stenosis?

A

Bruits, absent pupillary light response, arterial occlusion or ischemic damage to retina

57
Q

What is a Hollenhorst plaque?

A

Cholesterol embolus in retinal vessel

58
Q

What is the first test dx of carotid artery stenosis and what is the gold standard?

A

Carotid duplex u/s (very sensitive and specific)

Cerebral angiography is standard but rarely performed

59
Q

What are some risk equivalents for coronary heart disease?

A

PAD or carotid artery stenosis

60
Q

Tx for symptomatic carotid artery stenosis

A

Revascularization by carotid endarterectomy or carotid artery stenting

X Clin Med Final (5 decks)

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