SM 137 Peripheral Vascular Disease Flashcards
What is Peripheral Arterial Disease?
PAD is stenotic or occlusive arterial disease caused by atherosclerosis outside the heart
How can PAD present?
PAD may be asymptomatic, but can also present as intermittent claudication and critical limb ischemia
What is intermittent claudication?
Claudication is pain caused by a lack of blood flow and can be intermittent with worsening during exercise
What is critical limb ischemia?
Severe lack of blood flow to the limbs that results in severe pain and/or gangrene in the limb
How does age affect PAD?
PAD worsens with age
How does the extent of symptoms felt in PAD effect survival?
Severe symptomatic PAD has worse survival than asymptomatic PAD
How is PAD affected by cadiovascular mortality?
PAD in the setting of MI results in greater long term risks of overall cardiovascular mortality
What is the Rutherford Class system?
System used to describe Limb Threatening Ischemia, on a scale of 0 - 6
How does asymptomatic PAD compare to CLTI?
Asymptomatic PAD tends to result in stable claudication while CLTI tends to result mortality or amputation
What can improve CLTI prognonsis?
CLTI tends to progress to amputation and death, with outcomes being improved by revascularization
What are the risk factors for PAD?
Atherosclerosis, cigarette smoking, diabetes, hypertension, hyperlipidemia, and family history
Why does CLTI lead to pain at rest in the setting of PAD?
A mismatch between arterial supply and demand leads to ischemia, pain, and tissue loss
How does CLTI alter vessels?
CLTI can lead to development of collateral flow, but the collateral flow is insufficient; also leads to turbulent flow
How does CLTI compare to intermittent claudication?
Both cause pain, intermittent claudication resolves with rest while CLTI does not; CLTI = tissue loss
What options exist for PAD treatment?
Medical treatment and Surgical + Medical combination
What does medical treatment for PAD entail?
Walking therapy and CV risk factor modification
Who receives medical treatment for PAD?
Asymptomatic patients only
What are the surgical treatments for PAD?
Endartectomy, bypass graft, and endovascular patients; all in conjunction with medical therapy
Who receives surgical therapy for PAD?
Surgical therapy is pursued in PAD patients with symptoms such as CLTI, claudication, etc.
How does CV risk factor modification work?
Use CV Risk assessment to treat risk factors such as diabetes, hypertension, smoking, starting statins and antiplatelet therapy
How does walking therapy improve intermittent claudication?
Increases pain free walking distance
What is endartectomy?
Surgical removal of a plaque from an artery wall, used in symptomatic PAD
What are emerging treatments for PAD?
Gene therapy with VEGF and Stem cell therapy with bone marrow; aims to grow blood vessels and improve blood flow
What is Aortic Dissection?
Dissection of blood between and along the laminar planes of the media, leading to the formation of a blodo-filled false-lumen
Where is the false lumen in Aortic Dissection found?
The false-lumen is found in the aortic wall, between the Intima and Media
How does the false lumen in Aortic Dissection affect perfusion?
Blood flow can be seriously occluded during systole as the flap of the false lumen expands and shunts blood into the anuerysmal area
What are the typical traits of someone affected by Aortic Dissection?
More common in males, higher in African Americans, predisposed by connective tissue disorders