Peripheral Vascular Disease Flashcards
Claudication:
- Pain can be in
- Occurs after
- Sensation
- Condition is benign?
- Amputation risk
- resolves
- Pain can be in calf , thigh or buttock
- after consistent level of exercise
- aching, cramping sensation
- yes
- 3-5% risk depending on smoking
- resolves with rest
Rest pain:
- Pain
- Relief and made worse
- Additional symptoms
- Acute visit?
- Major consequence if left untreated
- tissue loss
- Skull, aching pain of foot or toes
- relieved by dependency and worsened by supine position
- paresthesia and pallor
- demands prompt attention
- does lead to limb loss in majority if untreated
- ulcer, dry gangrene
Which type of anuerysm is more prone to rupture?
Saccular
Physical exam is very reliable at identifying patients with PVD
true
PD physical exam
decreased pulses, bruits, muscle atrophy, atrophic shiny skin, hair loss, ulceration/gangrene, dependent rubor
PVD diagnosis
- functional
- anatomic
- how good is the flow? segmental pressures, pulse volume recording , duplex ultrasounds
- where and how severe is the vessel disease? MRA, contrast angiography and CT-angiogram
- doppler systolic occlusion pressure at ankle
- quantifies arterial obstruction
- falsely elevated with calcified arteries
- reliable functional bedside test
ankle brachial index (ABI)
medical therapy for claudication:
- behavioral
- pharmacologic
- smoking cessation, diet, activity and muscle training
2. BP control, statin, diabetes managment
Pletal (cilastozol)
phosphodiesterase inhibitor
vascular smooth muscle dilation, inhibits platelet aggregation
treating claudication improves
lifestyle
treating rest pain increases
limb preservation
gold standard for anatomic est
contrast arteriography
acute threatened limb ischemia: the 5 P’s
- pulselessness
- pallor
- pain
- paralysis
- paresthesia
acute threatened limb ischemia requires
immediate surgical attentions
acute, profound arterial insufficiency is usually
embolic
open aortofemoral bypass has better long term durabilty than endovascular tx but increased risk of surgery
yep
diabetes is a major risk factor for PVD. it affects the
distribution of diseased vessels and increases risk of foot ulcers and infection due to neuropathy
sensitive indicator of infection in diabetic foot
elevated glucose
diabetic foot infection treatment
- debridement
- antibiotics
- revascularization
most common location of a aortic aneurysm
infrarenal
epi of AAA
- affects
- men vs women
- increasing or decreasing incidence
- associated with
- 2-5% older than 60
- 4:1 male:female
- increasing incidence
- smoking/copd, HTN, CAD, family hystory
Acute AAA threatened rupture
- abd/back pain
- hypotension
- pulsatile abdominal mass
endograft
to repair aorta through femoral artery
in aortic dissection there is a spontaneous disruption of the
intima
aortic dissection commonly occurs
beyond left subclavian origin
aortic dissection:
- type B
- Type A
- involves descending aorta only
- acute tx. for malperfusion ‘stent’
- involves ascending aorta
- urgent repair
- high risk of rupture/ death within 48 hrs
stroke that only lasts minutes <24 hr
TIA
carotid atherosclerosis increased in patients with (2)
- CAD
2. PVD
physical exam for carotid atherosclerosis
- cervical bruit- 20% stenosis
- carotid and superficial temporal pulse
- neurologic exam
brachiocephalic atherosclerosis
- most common
- which subclavian artery involved more
- subclavian steal:
- carotid bifurcation
- left over right
- occlusion of proximal subclavian artery results in retrograde vertebral flow resulting in the development of CNS symptoms with arm exercise
diagnostic test for a extracranial carotid disease
duplex ultrasound
Atherosclerosis is stimulated by ____________ for flow abnormalities.
low shear stress
MRI is best used for patients with
TIA or stroke to assess for brain injury
contrast angiography is the gold standard but it is
reserved for selected cases such as VBI or aortic arch disease
magic number to operate for stenosis that is asymptomatic
75-80%
