PVD- Peripheral Vascular Disease Flashcards
What is PVD?
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
What is Claudication?
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)
What is intermittent claudication?
Pain in lower extremities with ambulation
Usually good prognosis
Low rate of amputation
What is limb threatening ischemia?
Limb pain at rest or ulceration/ gangrene in the limb
Poor diagnosis w/o treatment
High rate of amputation
What are the risk factors for lower extremity peripheral arterial occlusive disease?
Smoking
Diabetes
Explain worse prognostic factor= severity of occlusion at initial presentation
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
What are some medical management for lower extremity peripheral arterial occlusive disease?
Tobacco cessation in patients who smoke
Regular exercise
Control of lipid profile, diabetes and hypertension
What are pharmacotherapy interventions for lower extremity peripheral arterial occlusive disease?
Anti platelet agents
- aspirin
- clopidogrel
- cilostazol
- pentoxifylline
Antilipemic agents
- simvastain
What does surgery entail for lower extremity peripheral arterial occlusive disease?
Bypass surgery
Endo vascular therapy
Extracranial cerebrovascular disease can include diseases of the?
Aortic arch
Carotid arteries
Vertebrobasilar
Can Extracranial cerebrovascular disease be assymptomatic?
Yes
What can Extracranial cerebrovascular disease present as?
TIA
Amaurosis fugax- transient visual loss (TVL) results of an occlusion or stenosis of the internal carotid artery circulation
Extracranial cerebrovascular disease management?
Carotid angioplasty and stenting (CAS)
Carotid endarterectomy (CEA) - open procedure
CREST and CREST-2 Trials
Acute deep vein thrombosis mostly seen in what patients?
Non ambulatory patients
What is the most common form of venous disease?
Chronic venous insufficiency (CVI)
- non operative treatment commonly used
What does the functional presentation of CVI include?
Swelling, pain, ulceration of the lower extremities
Valvular incompetency results in increased hydrostatic pressure
Subcutaneous tissue thickening presents in a perimalleolar “gaiter” distribution
What is a mild CVI?
Mild to moderate ankle swelling
Usually limited to superficial veins
What is moderate CVI?
Hyperpigmentation
Non-pitting edema
Subcutaneous fibrosis w/o ulceration
What is severe CVI?
Ulceration
Stasis dermatitis (eczematoid skin changes)
Extensive involvement of deep venous systems
What are the goals for CVI management?
Control symptoms
Promote healing
Prevent symptom recurrence of venous stasis ulcers while allowing for normal ambulation
What are the interventions for CVI?
Bed rest and limb elevation
Compression stockings
Oral or IV antibiotics with cellulitis
Hydrocortisone cream
What is acute deep vein thrombosis?
Upper or lower extremities (more common in lower)
Upper extremity
- axillosubclavian
- common causes include TOS and catheter injuries
- Virchows triad- present under most circumstances
What are upper extremity symptoms of acute deep vein thrombosis?
Stabbing or aching pain in shoulder, axilla or arm
Swelling
Classic symptoms common in acute to compression
- weight lifting
- sleeping with arms overhead
What are lower extremity symptoms of acute deep vein thrombosis?
Swelling
Prominence of superficial veins
Dull pain
What is a pulmonary embolism?
Acute complication
Use of angiocoagulants reduces risk from 25 to 5%
What is post thrombotic syndrome?
Late complication
Chronic swelling
Venous insufficiency due to valvular damage
What is anticoagulantion therapy?
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
What is abdominal aortic aneurysm?
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
What are symptoms of aortic aneurysm?
Abdominal and back pain
What are treatments of aortic aneurysm?
Open repair
- placement of Dacron graft (synthetic)
Endovascular approach
- EVAR (endovascular aortic repair)
- transfemoral under fluoroscopy
What is peripheral artery aneurysms?
Popliteal artery aneurysm most common
Strong association with AAA
Focal dilation is its diameter is more than 50% of the normal vessel diameter
What are symptoms of peripheral artery aneurysm?
Pain behind the knee
An edema in the lower leg
Foot pain
Ulcers on the skin of the feet that don’t heal
What are treatments for peripheral artery aneurysms?
Open approaches
- posterior has been gold standard
Endovascular approaches
What are PVD complications?
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
