Peripheral Vascular Insufficiency Flashcards
Module 3
Chronic PAD is considered when symptoms are persistent for
Weeks or months
Acute PAD occurs when symptoms persist for
Hours or days
What is the most common cause of chronic arterial insufficiency?
PAD and atherosclerosis (more common in males)
Which patients are twice as likely to develop claudication?
Smokers
Patients with obstructive arterial disease are likely to have underlying
Artery disease and DM
What are characteristics that occur with PAD?
Muscle wasting, loss of hair, cold extremities, dependent rumor
What are 7 differential diagnoses for PAD?
Diabetic peripheral neuropathy, cauda quina syndrome, Buerger disease, upper extremity arterial disease, acute peripheral arterial occlusion, musculoskeletal conditions, and leg cramps
What initial diagnostic test should be done for PAD?
Doppler and ABI
Which lab tests should be done for PAD?
Serum glucose, lipid profile, high-sensitivity CRP, homocysteine, D-dimer, protein C and S, anti-thrombin III, anti-phospholipid antibodies, factor V leidin
Which ABI result indicates PAD?
< 0.9
What are imaging tests that can be done for PAD?
Digital subtraction angiography, color-assisted duplex US, MRA, CTA, venography
Iliac artery obstruction indicates which syndrome?
Leriche syndrome
What drugs should be used to manage PAD?
Daily aspirin, ACEIs, or ARBs
What drugs can be used as alternatives or in combination with aspirin and statin therapy
Dipyridamole, Ticlodipine, Clopidogrel
Which 2 drugs have shown an increase in walking distance for patients with claudication?
Pentoxifylline and Cilostazol
Pain with dorsiflexion is positive for
Homan’s sign - DVT
PAD is a risk factor for
AAA and pulmonary embolism (can occur in 2 weeks of DVT)
Acute arterial insufficiency can be caused by
Embolus from the heart or acute thrombosis from an atherosclerotic lesion
What history increases the risk of acute arterial insufficiency?
MI and/or atrial fibrillation and PVD
A physical exam of acute arterial insufficiency may reveal
Pale and pulseless limb with absent or diminished capillary refill, loss of sensation/immobility of the foot, sudden onset of pain
What are 2 diagnostic studies for acute arterial insufficiency?
Doppler studies and arteriography
What should be used in the management of acute arterial insufficiency?
Bolus of IV Heparin (5000 units)
Treatment of acute arterial insufficiency to avoid permanent injury, should be initiated within
6 hours of the occlusion
What are treatment options for acute arterial insufficiency?
Surgical or percutaneous embolectomy, percutaneous arterial thrombolytic delivery, IV thrombolytic therapy
Pulmonary embolism is a concern if involving the
Deep veins
Potential causes of PAD
Chronic venous stasis, varicose veins, venous stasis ulcerations, medications, presence of CHF, lymphatic obstruction, and malnutrition
What is the treatment for superficial vein phlebitis?
NSAIDs, elevated affected extremity, use of compression stockings/elastic bandage
Patients with an active diagnosis of cancer or undergoing chemotherapy will need anticoagulation for
3-6 months
Patients with no prior history of DVT and with reversible risk factors, require anticoagulation for
3 months
What management should be considered in patients with known recurrent DVT or have some contraindications with use of oral anticoagulation?
IVC filter
