Peripheral Vascular Disease

Question 1

What is the USPSTF recommendation for ultrasound screening for abdominal aortic aneurysm?

Answer 1

• one time screening for men ages 65-75 who have ever smoked grade B
• selectively test men who have never smoked (grade C)
• too little evidence to recommend in women who smoke (grade I)
• Do NOT screen women who have never smoked (grade D)

Question 2

Who does medicare part B cover for AAA screening?

Answer 2

• men age 65-75 who have ever smoked

- + family history of AAA in first degree relative

Question 3

At what size should you refer a patient for surgical intervention of AAA?

Answer 3

5-5.5 cm

Question 4

When should you repeat US for AAA based on initial size of…

3. 0-3.9 cm
4. 0-4.9 cm
5. 0-5.4 cm

Answer 4

3. 0-3.9 cm –> 36 mo
4. 0-4.9 cm –> 12 mo
5. 0-5.4 cm –> 6 mo

Question 5

In Aortic Dissection, what is a type A vs Type B and how are each likely to describe their symptoms?

Answer 5

Both describe ripping/tearing
Type A –> ascending aorta –> anterior chest pain
Type B –> descending aorta –> back pain

Question 6

Management of aortic dissection

Answer 6

2 goals:

• lower BP to sys 90-110 –> IV nitroprusside
• lower velocity of LV ejection –> IV esmolol

start with the beta blocker

Question 7

What is leriche syndrome in chronic arterial disease?

Answer 7

represents aortoilliac disease

symptoms are thigh, hip, buttock pain, with impotence

Question 8

How do you interpret ABI readings? What is normal, what is abnormal?

Answer 8

0.9-1.4 is normal
below 0.90 represents arterial disease
above 1.4 indicates noncompressible arteries

Question 9

Management of peripheral arterial disease

Answer 9

• smoking cessation
• control HTN and DM
• antiplatelet tx - aspirin or plavix, not DAPT
• Exercise, exercise, exercise
• Cilostazole (pletal) a phosphodiasterase inhibitor
• statin
• ramipril (can walk longer with less pain)

Question 10

When should you image someone with peripheral arterial disease?

Answer 10

Only when considering re-vascularization

Question 11

What are the symptoms of acute arterial occlusion?

Answer 11

5 Ps

• pain
• pallor
• paresthesias
• pulselessness
• paralysis

Don’t forget acute SMA occlusion: pain out of proportion with physical exam

Question 12

Treatment of acute arterial occlution

Answer 12

consult vascular surgeon

start heparin immediately

Question 13

What is blue toe syndrome and what do you do about it?

Answer 13

• arterioarterial emboli, caused by cholesterol or atherothrombotic emboli that occludes small vessels
• pulses remain present
• can involve multiple organs
• cholesterol crystals seen on fundoscopic exam
• no treatment, don’t give blood thinners since its not a clot