PVD Flashcards
the presence of an carotid bruit has what effect on cardiovascular outcomes?
- increased risk for MI and cardiovascular death
management of asymptomatic carotid stenosis
- treatment HTN
- treat hyperlipidemia
- treat DM
- stop smoking
- aspirin
carotid bruits are relatively common, occuring in approximately 4% of what population?
adults >45 y.o
does having a carotid bruit mean you have severe carotid stenosis?
- No, sensitivity of a carotid bruit for the detection of severe carotid stenosis is poor
- **however, specificity is more than 90%
symptomatic carotid stenosis 50-99% should be referred for what intervention techniques
- carotid endarterectomy
- carotid artery stenting
asymptomatic carotid stenosis 60-99% should be referred for what intervention techniques
- carotid endarterectomy
- carotid artery stenting not recommended
95% of atherosclerotic aneurysms affect which part of the aorta
abdominal aorta
what percentage of atherosclerotic aneurysms have symptoms prior to rupture
14% therefore high mortality
symptoms of ascending aortic aneurysm
- compression-swelling head/arms
- pain: chest, neck, back
- hoarseness
- valve regurgitation
symptoms of arch and descending aortic aneurysm
- wheezing, cough, SOB
- hemoptysis
- Hoarseness (RLN)
- dysphagia
- chest or back pain
management of thoracic aortic aneurysms
- beta blockers: decrease force of ejection
- angiotensin II receptor blockers
thoracic aortic aneurysms wider than what is an absolute indication for surgical/endovascular indications
5-6cm
Type A thoracic aortic dissection
Ascending aorta
- 75% of cases
Type B thoracic aortic dissection
Descending aorta
aortic dissection: potential signs and symptoms
- chest pain
- back pain (particularly between shoulder blades)
- HTN in 2/3 patients
Aortic dissections usually occur where
thoracic aorta
initial medical management of aortic dissection
- Beta blockers -> decrease force of ejection
- then vasodilators like Nipride -> reduce systolic BP
how is abdominal aortic aneurysms diagnosed
ultrasound
management of abdominal aortic aneurysms less than 5/5 cm, not enlarging rapidly, asymptomatic
ultrasound follow-up every 6-12 months
what are the indications for intervention of abdominal aortic aneurysms
- > 5.5 cm
- symptomatic
- rapid expansion: > 0.5 cm in 6-12 months
ruptured AAA associated with what symptoms
- abdominal pain
- pulsatile abd mass
- tenderness
- hypotension
AAA treatment
- resection and tube graft placement
- endovascular stent graft, often bifurcated: preferred
treatment of chronic aorto-iliac occlusive disease
- aortic bypass surgery
- endovascular: angioplasty +/- stenting
presentation of acute aorto-iliac occlusive disease
absent femoral pulses
treatment of acute aorto-iliac occlusive disease
***emergency
- quick imaging
- operate
characteristics of what condition?
- asymptomatic
- “intermittent claudication”
- critical leg ischemia-limb threat
peripheral arterial disease
what is the most common form of PVD? what is it caused by?
- peripheral arterial disease
- atherosclerosis
Name the symptoms of peripheral vascular disease
- claudication
- rest pain
- toes and dorsum of foot
- Leriche syndrome
what is Leriche syndrome present with
**aortoiliac disease
- decreased femoral pulses
- impotence
- buttocks and thigh claudication
- numbness and cold feeling develop as disease progresses
clinical presentation
- hair loss on leg/foot
- atrophic skin; nail changes
- ulcers
chronic arterial insufficiency
ankle brachial index. What is it and what it is used for? what is a normal value?
- ABI = ankle systolic pressure / brachial systolic pressure
- normally > or = to 1.0
- 95% sensitivity for chronic arterial insufficiency
most common sites affected with chronic arterial insufficiency
- superficial femoral
- popliteal
what is the main symptom of chronic arterial insufficiency
- claudication
- ischemic pain (crampy, tightening sensation) in the lower legs when walking
- pain resolves within minutes of stopping to rest
- most common in calves, less frequent in buttocks and thighs
claudication is usually associated with activity. Define the distance able to walk
- > 2 blocks = mild
- one block = moderate
- < 1 block = severe
why do 65-70% of claudication symptoms remain stable or improve with time
development of collateral vessels
if you have claudication, what other conditions would make the prognosis worse
- diabetes
- smoking
List Ankle Brachial index assesment of disease severity
- > or = 1: normal
- 0.70-0.99: mild
- 0.50-0.69: moderate
- < 0.50: severe
Name the various AB index that are associating with the following symptoms: no claudication, claudication, rest pain, limb threat
- no claudication: > 0.8
- claudication: 0.5-0.8
- rest pain: 0.2-0.49
- limb threat: < 0.2
in diabetic patients with calcified vessels, the ABI may change how?
be falsely high
- if > 1.1 think non-compressible vessels
first therapy for claudication
stop-start walking regimen
- regular daily walks 30-45 min/day
- at least 3 x/week for at least 6 months
therapy for claudication class I
- smoking cessation
- lipid-lowering therapy
- aspirin
what bypass graft is most common for femoral-popliteal revascularization
Goretex graft
presentation
- leg pain worsens with standing
- leg swelling
- varicosities
- worsens as day progresses
venous insufficiency
what are the 5 P’s of acute obstruction
- Pain
- Pallor
- Paresthesia
- Paralysis
- Pulselessness
compartment syndrome. List the 6 presenting P’s
commonly seen after reperfusion of ischemic limb, typically calf
- Pain out of proportion to finding
- Passive stretch pain
- Paresthesias
- Pokliothermia: abn temp regulation
- Paralysis
- Pulselessness
treatment of compartment syndrome
fasciotomy
surgical treatment of varicose veins
- sclerotherapy
- laser therapy
- vein stripping
first line management of varicose veins
- limb elevation 30 min 3-4 x/day to decrease edema
- compression therapy
