PVD/PAD

Question 1

List some occlusive diseases

Answer 1

• PAD
• atherosclerosis
• thrombosis/embolism
• vasculitis (Buerger’s, Raynauds, giant cell arteritis)

Question 2

Define claudication

Answer 2

pain with exertion that resolves with rest

Question 3

which medication can be used to improve symptoms & increase pain-free walking distances in patients with lower extremity PAD

Answer 3

Cilostazol

Question 4

What is normal ABI?

Answer 4

1+

Question 5

What are the most common areas of involvement for PAD

Answer 5

lower extremities or subclavian

Question 6

What are some risk factors for VTE

Answer 6

immobility, damage to veins/valves, pregnancy, medications (OCP), genetic clotting disorders, surgery, malignancy, travel

Question 7

What is the diagnostic gold standard for PE?

Answer 7

helical CT chest with contrast

Question 8

Does superficial thrombophlebitis become PE?

Answer 8

No because it is superficial

Question 9

Describe the etiology of PAD

Answer 9

Atherosclerotic plaque buildup narrows an artery causing ischemia to peripheral tissues & development of collateral vessels

Question 10

What are the MC signs & symptoms of PAD

Answer 10

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

Question 11

What is the gold standard test for PAD and a normal value

Answer 11

ankle-brachial index (Normal = 1+)

Question 12

Describe the etiology of critical limb ischemia

Answer 12

Can be a presentation of PAD pts

Significant ischemia that threatens the limb, insufficient arterial flow d/t thrombosis of atherosclerotic artery

Question 13

List the 6 P’s of critical limb ischemia

Answer 13

Pain, paresthesia, pallor, paralysis, pulselessness, poikilothermia (cold)

Question 14

Describe the etiology & RFs of venous thromboembolism

Answer 14

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

Question 15

Describe the gold standard diagnostics for a DVT and PE

Answer 15

DVT: duplex US of LE

PE: helical CT chest w/ contrast

(D-dimer high negative predictive value)

Question 16

Describe the treatment for venous thromboembolism

Answer 16

warfarin (INR goal 2-3) and SQ lovenox BID until warfarin is therapeutic

then DOACs to prevent clot from getting bigger/reduce risk/recurrence

Question 17

Describe the RF and etiology of thromboangiitis obliternas (Buerger’s)

Answer 17

MC young men, smoking

Inflammation of small-med size vessels in extremities, not atherosclerotic

Question 18

Describe the etiology & RFs for Raynaud’s

Answer 18

Finger & toe artery vasospasm

MC in F, young

Primary: symptoms occur without assoc disorder, bilateral, early onset, short episodes

Question 19

Describe the etiology of giant cell arteritis

Answer 19

vasculitis of med-large vessels (MC temporal arteritis)

Question 20

Describe the etiology of varicose veins

Answer 20

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

Question 21

Describe the etiology of chronic venous insufficiency

Answer 21

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

Question 22

Describe the clinical presentation of chronic venous insufficiency

Answer 22

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

Question 23

Describe the main differences between arterial & venous insufficiency

Answer 23