PVD/PAD Flashcards
List some occlusive diseases
- PAD
- atherosclerosis
- thrombosis/embolism
- vasculitis (Buerger’s, Raynauds, giant cell arteritis)
Define claudication
pain with exertion that resolves with rest
which medication can be used to improve symptoms & increase pain-free walking distances in patients with lower extremity PAD
Cilostazol
What is normal ABI?
1+
What are the most common areas of involvement for PAD
lower extremities or subclavian
What are some risk factors for VTE
immobility, damage to veins/valves, pregnancy, medications (OCP), genetic clotting disorders, surgery, malignancy, travel
What is the diagnostic gold standard for PE?
helical CT chest with contrast
Does superficial thrombophlebitis become PE?
No because it is superficial
Describe the etiology of PAD
Atherosclerotic plaque buildup narrows an artery causing ischemia to peripheral tissues & development of collateral vessels
What are the MC signs & symptoms of PAD
Symptoms: 20-50% asymptomatic (especially in those with DM), intermittent claudication, ischemic rest pain, non-healing ulcers, erectile dysfunction
Signs: diminished pulse pressure, bruits, pallor of foot on elevation, reactive hyperemia & dependent rubor, coolness, ulcers, hair loss, reduced/absent pulses
What is the gold standard test for PAD and a normal value
ankle-brachial index (Normal = 1+)
Describe the etiology of critical limb ischemia
Can be a presentation of PAD pts
Significant ischemia that threatens the limb, insufficient arterial flow d/t thrombosis of atherosclerotic artery
List the 6 P’s of critical limb ischemia
Pain, paresthesia, pallor, paralysis, pulselessness, poikilothermia (cold)
Describe the etiology & RFs of venous thromboembolism
Virchow’s Triad:
- alterations in blood flow (venous stasis)
- vascular endothelial injury
- alterations in blood constituents (inherited/acquired hypercoagulable state)
RF: immobility, damage to veins/valves, pregnancy, medications (OCP), genetic clotting disorders, surgery, malignancy, travel
Describe the gold standard diagnostics for a DVT and PE
DVT: duplex US of LE
PE: helical CT chest w/ contrast
(D-dimer high negative predictive value)
Describe the treatment for venous thromboembolism
warfarin (INR goal 2-3) and SQ lovenox BID until warfarin is therapeutic
then DOACs to prevent clot from getting bigger/reduce risk/recurrence
Describe the RF and etiology of thromboangiitis obliternas (Buerger’s)
MC young men, smoking
Inflammation of small-med size vessels in extremities, not atherosclerotic
Describe the etiology & RFs for Raynaud’s
Finger & toe artery vasospasm
MC in F, young
Primary: symptoms occur without assoc disorder, bilateral, early onset, short episodes
Describe the etiology of giant cell arteritis
vasculitis of med-large vessels (MC temporal arteritis)
Describe the etiology of varicose veins
Dilated, tortuous superficial veins, usually bilateral LE (MC great & small saphenous)
Incompetent valves, blood pooling, more pressure on competent valves - May indicate underlying venous insufficiency
MC F, onset in 40s
Describe the etiology of chronic venous insufficiency
MC cause of chronic LE edema
Pathophys: incompetent veins, extravasation of plasma, RBCs, plasma proteins, deposition of hemosiderin from lysed RBCs, scarring/fibrosis of subQ
Chronic elevation of venous pressure, valvular reflux d/t incompetence, blood pools in LE
Assoc with chronic disability, diminished quality of life, high healthcare cost
Hereditary or from trauma
Describe the clinical presentation of chronic venous insufficiency
Common to have LE pain, discomfort that worsens with standing/sitting, better with elevation/walking, abnormal venous dilation (reticular, varicosity), edema, inflammation, erythema, stasis dermatitis, ulceration, eczema, lipodermatosclerosis
Describe the main differences between arterial & venous insufficiency
