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Physical Conditions > PVD- Peripheral Vascular Disease > Flashcards

PVD- Peripheral Vascular Disease Flashcards

1
Q

What is PVD?

A

Also called peripheral artery disease (PAD)

Disease of arteries and/ or veins

Associated medical complications and issues (diabetes and renal insufficiency)

Organs and limbs may be affected

Chronic in nature with associated long-standing disability and functional implications

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2
Q

What is Claudication?

A

Supply vs demand

3 essential parts

1) pain is in functional muscle unit
2) pain is reproducible and precipitated by consistent exercise
3) promptly relieved by cessation of exercise

Objective diagnosis

  • ankle brachial blood pressures (ABI)
  • arteriography (MRA)
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3
Q

What is intermittent claudication?

A

Pain in lower extremities with ambulation

Usually good prognosis

Low rate of amputation

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4
Q

What is limb threatening ischemia?

A

Limb pain at rest or ulceration/ gangrene in the limb

Poor diagnosis w/o treatment

High rate of amputation

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5
Q

What are the risk factors for lower extremity peripheral arterial occlusive disease?

A

Smoking

Diabetes

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6
Q

Explain worse prognostic factor= severity of occlusion at initial presentation

A

Limb threatening ischemia occurs when restriction limits blood flow to the extent that metabolic demand so the tissues cannot be met during inactivity

Presents clinically as pain at rest in the distal portion of the extremity

Possibly ulceration

Possibly gangrene

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7
Q

What are some medical management for lower extremity peripheral arterial occlusive disease?

A

Tobacco cessation in patients who smoke

Regular exercise

Control of lipid profile, diabetes and hypertension

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8
Q

What are pharmacotherapy interventions for lower extremity peripheral arterial occlusive disease?

A

Anti platelet agents

  • aspirin
  • clopidogrel
  • cilostazol
  • pentoxifylline

Antilipemic agents
- simvastain

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9
Q

What does surgery entail for lower extremity peripheral arterial occlusive disease?

A

Bypass surgery

Endo vascular therapy

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10
Q

Extracranial cerebrovascular disease can include diseases of the?

A

Aortic arch

Carotid arteries

Vertebrobasilar

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11
Q

Can Extracranial cerebrovascular disease be assymptomatic?

A

Yes

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12
Q

What can Extracranial cerebrovascular disease present as?

A

TIA

Amaurosis fugax- transient visual loss (TVL) results of an occlusion or stenosis of the internal carotid artery circulation

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13
Q

Extracranial cerebrovascular disease management?

A

Carotid angioplasty and stenting (CAS)

Carotid endarterectomy (CEA)
- open procedure

CREST and CREST-2 Trials

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14
Q

Acute deep vein thrombosis mostly seen in what patients?

A

Non ambulatory patients

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15
Q

What is the most common form of venous disease?

A

Chronic venous insufficiency (CVI)

- non operative treatment commonly used

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16
Q

What does the functional presentation of CVI include?

A

Swelling, pain, ulceration of the lower extremities

Valvular incompetency results in increased hydrostatic pressure

Subcutaneous tissue thickening presents in a perimalleolar “gaiter” distribution

17
Q

What is a mild CVI?

A

Mild to moderate ankle swelling

Usually limited to superficial veins

18
Q

What is moderate CVI?

A

Hyperpigmentation

Non-pitting edema

Subcutaneous fibrosis w/o ulceration

19
Q

What is severe CVI?

A

Ulceration

Stasis dermatitis (eczematoid skin changes)

Extensive involvement of deep venous systems

20
Q

What are the goals for CVI management?

A

Control symptoms

Promote healing

Prevent symptom recurrence of venous stasis ulcers while allowing for normal ambulation

21
Q

What are the interventions for CVI?

A

Bed rest and limb elevation

Compression stockings

Oral or IV antibiotics with cellulitis

Hydrocortisone cream

22
Q

What is acute deep vein thrombosis?

A

Upper or lower extremities (more common in lower)

Upper extremity

  • axillosubclavian
  • common causes include TOS and catheter injuries
  • Virchows triad- present under most circumstances
23
Q

What are upper extremity symptoms of acute deep vein thrombosis?

A

Stabbing or aching pain in shoulder, axilla or arm

Swelling

Classic symptoms common in acute to compression

  • weight lifting
  • sleeping with arms overhead
24
Q

What are lower extremity symptoms of acute deep vein thrombosis?

A

Swelling

Prominence of superficial veins

Dull pain

25
Q

What is a pulmonary embolism?

A

Acute complication

Use of angiocoagulants reduces risk from 25 to 5%

26
Q

What is post thrombotic syndrome?

A

Late complication

Chronic swelling

Venous insufficiency due to valvular damage

27
Q

What is anticoagulantion therapy?

A

Should be started prompt unless contraindications

Absolute contraindications include:

  • intracranial bleeding
  • any sever active bleeding
  • recent brain, eye or SC surgery
  • pregnancy
  • malignant hypertension

Relative contraindications include

  • recent CVA
  • severe thrombocytopenia
  • recent surgery
28
Q

What is abdominal aortic aneurysm?

A

Focal dilation of the aorta of at least 50% greater than normal/ expected diameter

Mortality following rupture may exceed 90%

Mortality following elective repair 2-4%

Therefore repair for asymptotic AAA reserved for aneurysm > 5cm

29
Q

What are symptoms of aortic aneurysm?

A

Abdominal and back pain

30
Q

What are treatments of aortic aneurysm?

A

Open repair
- placement of Dacron graft (synthetic)

Endovascular approach

  • EVAR (endovascular aortic repair)
  • transfemoral under fluoroscopy
31
Q

What is peripheral artery aneurysms?

A

Popliteal artery aneurysm most common

Strong association with AAA

Focal dilation is its diameter is more than 50% of the normal vessel diameter

32
Q

What are symptoms of peripheral artery aneurysm?

A

Pain behind the knee

An edema in the lower leg

Foot pain

Ulcers on the skin of the feet that don’t heal

33
Q

What are treatments for peripheral artery aneurysms?

A

Open approaches
- posterior has been gold standard

Endovascular approaches

34
Q

What are PVD complications?

A

2/3 of all lower extremity amputations are result of PVD

When PVD is present usually multiple co-morbidities with multiple organ involvement

Vocational disruption

Psychological and emotional stress

Physical Conditions (14 decks)

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