SFP: peripheral vascular disease Flashcards
What process is the foundation of peripheral vascular disease?
Atherosclerosis
Where is peripheral artery disease often distributed?
Lower extremities
Peripheral artery disease increases risk of __.
All-cause mortality
Describe intermittent claudication.
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.
In intermittent claudication, where is the lesion?
1-2 levels above the affected muscle group.
What is an ankle-brachial index?
A comparison of the systolic BP in the ankle to that in the brachial artery.
An ankle-brachial index correlates with…
Degree of ischemia.
What are the treatment options for peripheral artery disease?
Reducing risk factors (HTN, cholesterol, etc.), exercise rehabilitation, footcare, and pharmacotherapies to address risk factors.
Why is smoking cessation important in treating peripheral artery disease?
Nicotine causes endothelial dysfunction and creates a prothrombotic environment and an inflammatory state. It also raises BP, creates insulin resistance, and alters lipid metabolism.
Smoking cessation has been shown to improve symptoms of…
Claudication.
How do statins impact peripheral artery disease?
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.
What medication has been shown to help with the diabetic influence on peripheral vascular disease?
Metformin.
What is the function of rosiglitazone?
It improves peripheral insulin sensitivity and reduces CV events.
What is the function of aspirin in peripheral vascular disease?
It inhibits platelet aggregation and reduces inflammatory cytokine production.
What is the function of cilostazol in peripheral vascular disease?
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.
Which medication has been shown to reduce amputation rate and improve walking distance?
Cilostazol.
What is the function of exercise therapy in those with peripheral vascular disease?
It improves metabolic capacity.
Typically, what is meant by exercise therapy in peripheral vascular disease?
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.
What is the life’s essential 8?
Put out by the AAA; gives 8 lifestyle habits to reduce risk of peripheral artery disease.
Advanced chronic limb threatening ischemia typically leads to ___.
Gangrene.
what are the symptoms of advanced chronic limb threatening ischemia.
Ischemic rest pain that causes severe burning along metatarsals that is aggravated by elevation. Patients often hang their foot off the bed.
How do we distinguish ischemic rest pain from diabetic peripheral neuropathy?
Ischemic rest pain is positional.
A non-healing wound is a sign of ___.
Chronic limb threatening ischemia.
What are signs of chronic limb threatening ischemia?
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.
Is wet or dry gangrene an indication for surgical emergency?
Wet.
What determines if we get imaging?
If considering surgery/ if limb loss is a threat.
How can we diagnose chronic limb threatening ischemia?
Color duplex ultrasonography, arteriography, MRA, CTA.
What is the goal in treatment of chronic limb threatening ischemia?
Relieve symptoms and prevent limb loss.
What is an issue with operating on those with chronic limb threatening ischemia?
They often have several comorbidities.
What are the treatments of chronic limb threatening ischemia?
Endovascular therapy (PTA with or without stent).
What is the 1-year success in surgical intervention in the common iliac?
85%.
What is the 1-year success in surgical intervention in the external iliac?
70%.
What is the 1-year success in surgical intervention of superficial femoral?
50%.
What is paclitaxel?
A lipophilic chemotherapeutic that breaks down microtubules to prevent cell division.
What is sirolimus?
Often used on balloons to inhibit cell proliferation.
What is the general surgical treatment of chronic limb threatening ischemia?
Bypass; creating a route for blood to get through; larger vessels tend to have more success as there is generally more flow.
If revascularization is not successful, what tends to be a treatment option?
Primary amputation.
What are indicators that an amputation will be necessary?
Continued smoking and rest pain on presentation.
What helps determine the level of amputation?
Functional potential of the patient.
