SFP: peripheral vascular disease

Question 1

What process is the foundation of peripheral vascular disease?

Answer 1

Atherosclerosis

Question 2

Where is peripheral artery disease often distributed?

Answer 2

Lower extremities

Question 3

Peripheral artery disease increases risk of __.

Answer 3

All-cause mortality

Question 4

Describe intermittent claudication.

Answer 4

Pain or fatigue of muscles with exercise; it is reproducible (happens at the same point each time). It gets better after stopping activity for a few minutes.

Question 5

In intermittent claudication, where is the lesion?

Answer 5

1-2 levels above the affected muscle group.

Question 6

What is an ankle-brachial index?

Answer 6

A comparison of the systolic BP in the ankle to that in the brachial artery.

Question 7

An ankle-brachial index correlates with…

Answer 7

Degree of ischemia.

Question 8

What are the treatment options for peripheral artery disease?

Answer 8

Reducing risk factors (HTN, cholesterol, etc.), exercise rehabilitation, footcare, and pharmacotherapies to address risk factors.

Question 9

Why is smoking cessation important in treating peripheral artery disease?

Answer 9

Nicotine causes endothelial dysfunction and creates a prothrombotic environment and an inflammatory state. It also raises BP, creates insulin resistance, and alters lipid metabolism.

Question 10

Smoking cessation has been shown to improve symptoms of…

Answer 10

Claudication.

Question 11

How do statins impact peripheral artery disease?

Answer 11

They decrease pro-inflammatory cytokines and vessel inflammation, decrease platelet reactivity, and decrease vascular smooth muscle cell proliferation to stabilize a fibrous cap of a plaque.

Question 12

What medication has been shown to help with the diabetic influence on peripheral vascular disease?

Answer 12

Metformin.

Question 13

What is the function of rosiglitazone?

Answer 13

It improves peripheral insulin sensitivity and reduces CV events.

Question 14

What is the function of aspirin in peripheral vascular disease?

Answer 14

It inhibits platelet aggregation and reduces inflammatory cytokine production.

Question 15

What is the function of cilostazol in peripheral vascular disease?

Answer 15

It is specifically for patients with claudication. It is a phosphodiesterase 3 inhibitor that acts as a vasodilator, anti-proliferative, and anti-platelet. It is particularly useful in skeletal muscle.

Question 16

Which medication has been shown to reduce amputation rate and improve walking distance?

Answer 16

Cilostazol.

Question 17

What is the function of exercise therapy in those with peripheral vascular disease?

Answer 17

It improves metabolic capacity.

Question 18

Typically, what is meant by exercise therapy in peripheral vascular disease?

Answer 18

Gym sessions to walk on a treadmill that feature advancement in grade, speed, and duration. This improves maximal walking time and pain-free walking time.

Question 19

What is the life’s essential 8?

Answer 19

Put out by the AAA; gives 8 lifestyle habits to reduce risk of peripheral artery disease.

Question 20

Advanced chronic limb threatening ischemia typically leads to ___.

Answer 20

Gangrene.

Question 21

Describe advanced chronic limb threatening ischemia.

Answer 21

Ischemic rest pain that causes severe burning along metatarsals that is aggravated by elevation. Patients often hang their foot off the bed.

Question 22

How do we distinguish ischemic rest pain from diabetic peripheral neuropathy?

Answer 22

Ischemic rest pain is positional.

Question 23

A non-healing wound is a sign of ___.

Answer 23

Chronic limb threatening ischemia.

Question 24

What are signs of chronic limb threatening ischemia?

Answer 24

Reduced pulse exam but still palpable in the femoral, pallor on elevation, reactive hyperemia upon lowering the foot from elevated position, rubor, cool skin temperature, ulceration/gangrene.

Question 25

Is wet or dry gangrene an indication for surgical emergency?

Answer 25

Wet.

Question 26

What determines if we get imaging?

Answer 26

If considering surgery/ if limb loss is a threat.

Question 27

How can we diagnose chronic limb threatening ischemia?

Answer 27

Color duplex ultrasonography, arteriography, MRA, CTA.

Question 28

What is the goal in treatment of chronic limb threatening ischemia?

Answer 28

Relieve symptoms and prevent limb loss.

Question 29

What is an issue with operating on those with chronic limb threatening ischemia?

Answer 29

They often have several comorbidities.

Question 30

What are the treatments of chronic limb threatening ischemia?

Answer 30

Endovascular therapy (PTA with or without stent).

Question 31

What is the 1-year success in surgical intervention in the common iliac?

Answer 31

85%.

Question 32

What is the 1-year success in surgical intervention in the external iliac?

Answer 32

70%.

Question 33

What is the 1-year success in surgical intervention of superficial femoral?

Answer 33

50%.

Question 34

What is paclitaxel?

Answer 34

A lipophilic chemotherapeutic that breaks down microtubules to prevent cell division.

Question 35

What is sirolimus?

Answer 35

Often used on balloons to inhibit cell proliferation.

Question 36

What is the general surgical treatment of chronic limb threatening ischemia?

Answer 36

Bypass; creating a route for blood to get through; larger vessels tend to have more success as there is generally more flow.

Question 37

If revascularization is not successful, what tends to be a treatment option?

Answer 37

Primary amputation.

Question 38

What are indicators that an amputation will be necessary?

Answer 38

Continued smoking and rest pain on presentation.

Question 39

What helps determine the level of amputation?

Answer 39

Functional potential of the patient.