Peripheral Vascular Disease Lecture Powerpoint

Question 1

Peripheral arterial disease

Answer 1

Atherosclerosis of blood vessels other than the coronary or cerebral arteries leading to obstruction

Question 2

Atypical leg pain

Answer 2

Lower extremity discomfort that is exertional but does not consistently resolve with rest or consistently limit exercise at a reproducible distance making it different from intermittent claudication but still a finding in peripheral arterial disease

Question 3

Intermittent claudication

Answer 3

Reproducible discomfort of a defined group of muscle that is induced by exercise and relieved upon rest, classic finding of peripheral arterial disease

Question 4

Critical limb ischemia

Answer 4

Ischemic rest pain, a non healing wound, or gangrene due to progression from claudication resulting in severe peripheral arterial disease

Question 5

The 5 P’s of acute limb ischemia that indicate severe peripheral arterial disease

Answer 5

Pain
Pulseless
Pallor
Paresthesias
Paralysis
Poikilothermia (the rare 6th P)

Question 6

Ankle brachial index and value ranges

Answer 6

• Division of the lower extremity systolic pressure by the brachial artery systolic pressure to determine if there is arterial disease causing claudication to the lower extremity
• value of 1 is normal and values less than .8 indicate moderate to severe arterial disease

Question 7

Absent femoral pulses can indicate ___ disease (peripheral arterial disease)

Answer 7

iliac artery

Question 8

Gradation of pulse intensity on physical exam

Answer 8

0 - absent
1 - diminished
2 - normal
3 - strong
4 - bounding

Question 9

Some common differential diagnoses of peripheral arterial disease (3)

Answer 9

• degenerative joint disease
• venous insufficiency
• chronic compartment syndrome

Question 10

Gold standard diagnostic for evaluation of peripheral arterial disease

Answer 10

Peripheral angiography

Question 11

Treatment of peripheral arterial disease (6)

Answer 11

• Statin
• Antihypertensives
• Aspirin or plavix (antiplatelet therapy)
• Pletal (effective at improving symptoms and increasing walking distance in patients with PAD and claudication)
• revascularization
• amputation

Question 12

Revascularization therapy

Answer 12

Indicated treatment in patients with significant or disabling symptoms unresponsive to lifestyle adjustment or medical therapy or in patients with limb threatening ischemia to establish arterial blood flow either by angioplasty (bipass), or stenting

Question 13

Superficial varicosities

Answer 13

A very common form of peripheral venous disease that is due to inadequate muscle pump function, incompetent venous valves, or venous thrombosis and obstruction

Question 14

Peripheral venous disease presentation vs peripheral arterial disease

Answer 14

• Venous has leg swelling and aching

- Arterial has sharp intermittent pain

Question 15

Treatment of peripheral venous disease (2)

Answer 15

• leg elevation and compression socks

- surgical excision

Question 16

Superficial phlebitis

Answer 16

Presence of pain and inflammation involving a vein in absence of a thrombus from venous stasis, procedures, infection, or IV therapy

Question 17

Unprovoked vs provoked and proximal vs distal DVTs

Answer 17

Unprovoked - no identifiable environmental event
Provoked - caused by known event such as surgery, hospitalization, immobility etc.

Proximal - within the popliteal, femoral, or iliac veins
Distal - below the knee and confined to calf veins (peroneal, posterior tibial, anterior tibial veins)

Question 18

Virchow’s triad

Answer 18

• Hypercoaguable state
• intimal trauma
• venous stasis

Question 19

Upper extremity DVT

Answer 19

Rare form of DVT occurring in subclavian, axillary, or brachial veins

Question 20

Well’s score

Answer 20

System used to assess clinical probability of DVT with 0 points being low probability, 1-2 being moderate, and 3-8 being high probability

Question 21

D Dimer test for DVT

Answer 21

Elevated in nearly all patients with acute DVT so highly sensitive however picks up many false positives from any other clot formed in body, so should only be used to rule out DVT

Question 22

Postthrombotic syndrome (PTS)

Answer 22

Chronic venous insufficiency developed following DVT due to a combination of refulx due to valvular incompetence and venous hypertension from former thrombotic obstruction

Question 23

DVT prevention DOC

Answer 23

Low molecular weight heparin (no lab monitoring required, and has high bioavailability, only con is it has to be injected subQ)

Question 24

Treatment of DVT

Answer 24

• Initial anticoagulants (LMWH, apixaban)
• long term anticoagulation (warfarin, LMWH)
• Thrombolytics (TPA)

Question 25

IVC filter

Answer 25

Used in patients who have contraindication to anticoagulant therapy for DVT prevention, used to catch clots