PVD Flashcards
MCC of PVD
Atherosclerosis most common cause
Coronary dz is present in what percentage of people with atherosclerosis
Coronary disease present in >50%
mortality with PAD
Mortality 2-3x greater vs general population
Prevalence of CAD with age
3% (40-59 years)
8% (60-69 years)
19% (>70 years)
commone sxs of PAD
pain with walking + missing pulse
=PAD
Venous reflux disease is__-more prevalent than coronary heart disease (CHD) and ___ more prevalent than peripheral arterial disease (PAD)1
Venous reflux disease is 2x more prevalent than coronary heart disease (CHD) and 5x more prevalent than peripheral arterial disease (PAD)1
PAD is more commonly see in what population
older people and women
what percentage of people with sx reflux seek tx?
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
PAD is usually due to
astheroclerotic dz that leads to narrowing
where do you see astherosclerosis
horrible inflammatory process of arterial wall not usually seen in aprta
Venous insufficiency is the result of _____ of the venous vessels in the legs.
Venous insufficiency is the result of over-dilation of the venous vessels in the legs.
how to assess if venous reflux is prescent
To assess if venous reflux is present, a duplex ultrasound scan is performed
risk factors for PAD
Diabetes Smoking History of CAD Elevated cholesterol or decreased HDL Hypertension Sedentary lifestyle Obesity Male gender Age
Risk factors of venous insufficiency:
Gender
Age
Heredity
Pregnancy
Standing occupation
Obesity
Prior injury or surgery
Sedentary lifestyle
Approximately ___ as many women as men are affected by varicose veins, suggesting that female hormones may be a risk factor
Gender: Approximately four times as many women as men are affected by varicose veins, suggesting that female hormones may be a risk factor
Symptoms of venous insufficiency
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
Pain in calf with walking that resolves with rest
: Claudication
common Hx in pt with PAD
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
Atypical Sx of PAD
” Pain in the ankle with walking
“ Rest pain may manifest in one toe
Fatigue in calf while walking
“
DM that smoke % chance of PAD
29%
PE
Skin color, hair loss, skin necrosis or ulceration, edema or bulging veins or asymmetry
hallmarks of venous ulcers
wet
and often painless
aterial ulcers are often very painful
where should you listen when evaluating a pt with suspected arterial dz
” 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
what would you suspect in an older and younger person with different blood pressures on each arm
older person =subclavian artery stenosis
younger person= coarctation of the aorta
ABI number indications
normal
moderate
and
severe
” > 0.9 is normal
“ >0.4-0.9 moderate disease and suspect of PAD
“ <0.4 indicates severe disease
two main limitations of ABI
Calcified ankle vessels
result in artificially
“normal” ABI (DM, RF)
Normal ABI in patient
with Aortoiliac Disease—
only becomes abnormal
with exercise testingtwo classifications of PAD
fontaine and rutherford
GOLD STANDARD of dx PAD
Digital subtraction angiography
” Alternatives to contrast include carbon dioxide and gadolinium
Usually done in conjunction with a therapeutic treatment
” Need iodine contrast
” Digital subtraction angiography
drug therapy
for PAD
Cilostozol
ASA - antiplatelet - clopidogrel…but don’t really need it if your pt is on cilostozol
lipid lowering drugs (statins)
when would cilostozol be contraindicated
Avoid in pt with poor LV function.
because this is a phosphodiesterase inhibitor
how does cilostozol tx PAD
Combined antiplatelet and vasodilatory effects
lifestyle tx for the managment of PAD
Exercise training- blood vessels will get in better shape
Risk factor modification
Smoking cessation
Lipid lowering therapy
Diabetes control
Weight loss
BP control
Treatment: Venous Disease
Compression stockings Diuretics, weight loss Wound care Surgical stripping Percutaneous ablation techniques Replacing surgery now
Treatment: Endovascular Intervention
Balloon angioplasty Self-expanding and balloon-expandable stents Atherectomy Laser Cryoplasty Mechanical thrombectomy Intra-arterial thrombolytic therapy Stent-grafts* Aneurysm coiling/Vascular embolization
Treatment: Surgery
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
what is the cut off of flow in duplex scanning
3.5 is the cut off
where would we expect to see the area of claudication in aortic bifurcation or common iliac
buttock, hip, groin
leriche’s triad
seen with common iliac or bifurcation aorta
- claudication in butt or thigh
- impotence.
- decreased femoral pulse
femoral artery caludication we would see where
thigh and upper calf
poplitial artery caludication would be seen
in the lower calf
resting pain seen with PAD is considered
advanced and limb threatening
acute arterial embolism is usually seen as the
6 P’s
paresthesias pain pallor pulseleness paralysis poikilothermia
abdominal bruits may indicate
renal or mesenteric vascular stenosis
gold standard for PAD dx
digital subtraction agiography
but normally we use ABI
hand held doppler can also be used and is frequently done so in the ER
Three platlet inhibitors for the mngmt of PAD
- cilostazol (not w/ poor lvr funct)
helps with intermiten claudication - ASA
- clopodogrel (plavix)
