PVD

Question 1

PVD def

Answer 1

The presence of arterial stenosis or occlusion in the aorta or limbs

It’s a marker for co- exsistent CAD

Question 2

Clinical manifestations

Answer 2

Asymptomatic 
Intermittent claudication 
    - discomfort ache cramp leg ( exercise )
Functional impairment 
  - slow speed, low distance 
Rest pain 
   - pain/ parathesias feet/toes 
   - worsens with elevation 
Ischemic ulceration 
  - gangrene, ampuatations

Question 3

PVD PE findings

Answer 3

Skin cool, tight, shiny w/ hair loss - arterial

Edema absent or mild

Nails thickened and ridged
Pallor w. Elevation , rub or w. Dependency

Decrease pulse
Painful ulcers on toes and feet
Skin around ulcer w/o pigment

Refer to vascular surgeon

Question 4

Ankle- Brachial index

Answer 4

Comparing BP in arm to ankle which can reveal PAD

A large difference can = PAD low reading means that blood is having a hard time getting to the lower extremities

Normal = .91 to .1.3
.41 to .9 = moderate PAD
Severe PAD = <0.4

Question 5

TX goals

Answer 5

Limb outcomes - prevent limb ischemia/ amputation improve walking distance, QOL

Outcomes in CV morbidity/Mortality - decrease MI, Stroke, CV disease

Question 6

ASA

Answer 6

Primary prevention

Not evidence about elderly

Question 7

Plavix

Answer 7

75 mg once daily
Favored to prevent stroke and PVD symtpoms

Don’t use with ASA

Question 8

Arterial insufficiency

Answer 8

Skin cool, hair loss common
Decreased pulses 
Typically no swelling 
Painful ulcer  gangrene 
Red with dependency and blanched with elevation 
Thicken nails

Question 9

Venous insufficiency

Answer 9

Skin temp normal 
Pulses normal 
Edema present 
Painful - varies 
Brown spots
Blueish hue on dependency 
Stasis ulcerations on medical side of ankle, but not painful, no gangrene

Question 10

Stasis dermatitis and Ulcers , def, location, look, TX

Answer 10

Common inflammatory dermatitis of lower extremities occurring in patients with chronic venous insufficiency

Medial ankle
Scaling and eczema patch or plaques on chronically edematous legs

May have pruritus but may result in lichenification from chronic scratching

TX: reduce edema, skin care, avoid local trauma, seen eval

Question 11

Arterial insufficiency and Ulcers

Answer 11

Ischemic skin changes involving Lower foot/ lower extremities due to insufficient blood supply

Often asymptomatic

Location : feet/toes, shin, bony prominences
Non healing ulcer - gangrene
Cold pale extremities
Sensory loss

Question 12

TX of intermittent claudication

Answer 12

Exercise therapy, drug therapy, selective use of revasularization

Question 13

AAA

Answer 13

Localized enlargement of diameter of abdominal aorta , associated with sig morbidity and mortality

Question 14

AAA types

Answer 14

Fusiform
- most common, cylindrical , affecting entire circumference of aorta

Saccular
- asymmetrical, affecting only a portion, form an infectious cause

Question 15

Screening for AAA

Answer 15

One time US fro med 65-75 who have ever smoked

Question 16

Guideline to monitor vs repair

Answer 16

< 4 = US every 2-3 years
4-5 = US or CT q 6-12 m
>5.5 = repair

If symptomatic = repair any diameter

Question 17

AAA management

Answer 17

Stop smoking, blood pressure, lipids