PVD

Question 1

MCC of PVD

Answer 1

Atherosclerosis most common cause

Question 2

Coronary dz is present in what percentage of people with atherosclerosis

Answer 2

Coronary disease present in >50%

Question 3

mortality with PAD

Answer 3

Mortality 2-3x greater vs general population

Question 4

Prevalence of CAD with age

Answer 4

3% (40-59 years)
8% (60-69 years)
19% (>70 years)

Question 5

commone sxs of PAD

Answer 5

pain with walking + missing pulse

=PAD

Question 6

Venous reflux disease is__-more prevalent than coronary heart disease (CHD) and ___ more prevalent than peripheral arterial disease (PAD)1

Answer 6

Venous reflux disease is 2x more prevalent than coronary heart disease (CHD) and 5x more prevalent than peripheral arterial disease (PAD)1

Question 7

PAD is more commonly see in what population

Answer 7

older people and women

Question 8

what percentage of people with sx reflux seek tx?

Answer 8

Statistics show that of the 25 million people in the U.S. who suffer from symptomatic reflux, only about 5% seek treatment annually; 2/3 of patients who do seek treatment have saphenous reflux

Question 9

PAD is usually due to

Answer 9

astheroclerotic dz that leads to narrowing

Question 10

where do you see astherosclerosis

Answer 10

horrible inflammatory process of arterial wall not usually seen in aprta

Question 11

Venous insufficiency is the result of _____ of the venous vessels in the legs.

Answer 11

Venous insufficiency is the result of over-dilation of the venous vessels in the legs.

Question 12

how to assess if venous reflux is prescent

Answer 12

To assess if venous reflux is present, a duplex ultrasound scan is performed

Question 13

risk factors for PAD

Answer 13

Diabetes
Smoking
History of CAD
Elevated cholesterol
	or decreased HDL 
Hypertension 
Sedentary lifestyle
Obesity
Male gender
Age

Question 14

Risk factors of venous insufficiency:

Answer 14

Gender

Age

Heredity

Pregnancy

Standing occupation

Obesity

Prior injury or surgery

Sedentary lifestyle

Question 15

Approximately ___ as many women as men are affected by varicose veins, suggesting that female hormones may be a risk factor

Answer 15

Gender: Approximately four times as many women as men are affected by varicose veins, suggesting that female hormones may be a risk factor

Question 16

Symptoms of venous insufficiency

Answer 16

Leg pain, aching, or cramping

Burning or itching of the skin

Leg or ankle swelling

“Heavy” feeling in legs

Skin discoloration or texture changes

Open wounds or sores

Restless legs

Varicose Veins

Question 17

Pain in calf with walking that resolves with rest

Answer 17

: Claudication

Question 18

common Hx in pt with PAD

Answer 18

pain in calf with walking that resolves with rest: Claudication

Area of pain can suggest level of dz.

Differentiate from pseudo claudication

Pain at rest in the affected extremity

Sores or ulcers that do not heal

Non-specific leg heaviness and fatigue

Pain and itching in varicose veins

Question 19

Atypical Sx of PAD

Answer 19

” Pain in the ankle with walking
“ Rest pain may manifest in one toe

Fatigue in calf while walking
“

Question 20

DM that smoke % chance of PAD

Answer 20

29%

Question 21

PE

Answer 21

Skin color, hair loss, skin necrosis or ulceration, edema or bulging veins or asymmetry

Question 22

hallmarks of venous ulcers

Answer 22

wet
and often painless
aterial ulcers are often very painful

Question 23

where should you listen when evaluating a pt with suspected arterial dz

Answer 23

” Listen over the carotids and femorals for bruits
Abdominal bruits may indicate renal or mesenteric vascular stenosis

Cardiac auscultation: Valvular stenosis or regurgitation; unlikely to hear vascular bruits.

Aortic stenosis can radiate to carotids

Question 24

what would you suspect in an older and younger person with different blood pressures on each arm

Answer 24

older person =subclavian artery stenosis

younger person= coarctation of the aorta

Question 25

ABI number indications
normal

moderate
and
severe

Answer 25

” > 0.9 is normal
“ >0.4-0.9 moderate disease and suspect of PAD
“ <0.4 indicates severe disease

Question 26

two main limitations of ABI

Answer 26

Calcified ankle vessels
    result in artificially 
      “normal” ABI (DM, RF)
      Normal ABI in patient
    with Aortoiliac Disease—
  only becomes abnormal
with exercise testing

Question 27

two classifications of PAD

Answer 27

fontaine and rutherford

Question 28

GOLD STANDARD of dx PAD

Answer 28

Digital subtraction angiography

Question 29

” Alternatives to contrast include carbon dioxide and gadolinium

Usually done in conjunction with a therapeutic treatment

” Need iodine contrast

Answer 29

” Digital subtraction angiography

Question 30

drug therapy

for PAD

Answer 30

Cilostozol

ASA - antiplatelet - clopidogrel…but don’t really need it if your pt is on cilostozol

lipid lowering drugs (statins)

Question 31

when would cilostozol be contraindicated

Answer 31

Avoid in pt with poor LV function.

because this is a phosphodiesterase inhibitor

Question 32

how does cilostozol tx PAD

Answer 32

Combined antiplatelet and vasodilatory effects

Question 33

lifestyle tx for the managment of PAD

Answer 33

Exercise training- blood vessels will get in better shape

Risk factor modification
     Smoking cessation
     Lipid lowering therapy
     Diabetes control
      Weight loss
      BP control

Question 34

Treatment: Venous Disease

Answer 34

Compression stockings
Diuretics, weight loss
Wound care
Surgical stripping
Percutaneous ablation techniques
Replacing surgery now

Question 35

Treatment: Endovascular Intervention

Answer 35

Balloon angioplasty
Self-expanding and balloon-expandable stents
Atherectomy 
Laser
Cryoplasty
Mechanical thrombectomy
Intra-arterial thrombolytic therapy
Stent-grafts*
Aneurysm coiling/Vascular embolization

Question 36

Treatment: Surgery

Answer 36

most are getting replaced x e

Tried and true methods
Most techniques employ some form of vascular bypass
Aortic aneurysm repair
Carotid endarterectomy
Many surgeries are being replaced by much less traumatic endovascular procedures

Question 37

what is the cut off of flow in duplex scanning

Answer 37

3.5 is the cut off

Question 38

where would we expect to see the area of claudication in aortic bifurcation or common iliac

Answer 38

buttock, hip, groin

Question 39

leriche’s triad

Answer 39

seen with common iliac or bifurcation aorta

1. claudication in butt or thigh
2. impotence.
3. decreased femoral pulse

Question 40

femoral artery caludication we would see where

Answer 40

thigh and upper calf

Question 41

poplitial artery caludication would be seen

Answer 41

in the lower calf

Question 42

resting pain seen with PAD is considered

Answer 42

advanced and limb threatening

Question 43

acute arterial embolism is usually seen as the

Answer 43

6 P’s

paresthesias
pain
pallor
pulseleness
paralysis
poikilothermia

Question 44

abdominal bruits may indicate

Answer 44

renal or mesenteric vascular stenosis

Question 45

gold standard for PAD dx

Answer 45

digital subtraction agiography

but normally we use ABI
hand held doppler can also be used and is frequently done so in the ER

Question 46

Three platlet inhibitors for the mngmt of PAD

Answer 46

1. cilostazol (not w/ poor lvr funct)
   helps with intermiten claudication
2. ASA
3. clopodogrel (plavix)