Peripheral Vascular Disease: Evaluation, Differential Diagnosis, Prognosis

Question 1

What is occlusive peripheral arterial disease (PAD)

Answer 1

Chronic, occlusive arterial disease of medium and large sized vessels, the result of peripheral atherosclerosis

Question 2

What is PAD associated with

Answer 2

hypertension and hyperlipidemia
- pts may also have CAD, cerebrovascular disease, diabetes, metabolic syndrome, and a history of smoking

Question 3

PAD affect on pulses

Answer 3

• diminished blood supply to affected extremities with pulses decreased or absent

Question 4

PAD color

Answer 4

pale on elevation; dusky red on dependency

Question 5

early stages of PAD

Answer 5

• patients exhibit intermittent claudication
• pain is described as burning, searing, aching, tightness, or cramping
• occurs regulars and predictably with walking and is relieved by rest

Question 6

Later stages of PAD

Answer 6

• pts exhibit rest pain, muscle atrophy, trophic changes (hair loss, skin and nail changes)Cr

Question 7

Occlusive stenosis PAD

Answer 7

• patients exhibit resting or nocturnal pain, skin ulcers, and gangrene

Question 8

Which extremities does PAD mostly affect?

Answer 8

lower extremities

Question 9

Diabetic angiopathy

Answer 9

• arterial disease
• an inappropriate elevation of blood glucose levels and accelerated atherosclerosis
• neuropathy is a major complication
• neurotrophic ulcers may lead to gangrene and amputation

Question 10

Raynaud’s disease/Phenomenon

Answer 10

• episodic spasm of small arteries and arterioles
• abnormal vasoconstrictor reflex exacerbated by exposure to cold or emotional stress; tips of fingers develop pallor, cyanosis, numbness, and tingling
• affects largely females
• occlusive disease is not usually a factor

Question 11

Varicose Veins

Answer 11

• distended, swollen superficial veins; tortuous in appearance
• may lead to varicose ulcers

Question 12

Venous Thromboembolism (VTE)

Answer 12

• the formation of a blood clot in a deep vein that lead to complications including deep vein thrombosis (DVT), PE, or postthrombotic syndrome (PTS)
• can become chronic: post-thrombotic syndrome, leads to decreased quality of life

Question 13

Mortality of VTE

Answer 13

• incidence of 10%-30% within 1 month of diagnosis

Question 14

Morbidity of VTE

Answer 14

• 1/3 experiences another VTE within 10 years

Question 15

Deep Vein Thrombophlebitis

Answer 15

• clot formation and acute inflammation in a deep vein
• usually occurs in LEs, associated with forced immobilization, surgery, trauma, and hyperactivity of blood coagulation or can be unprovoked

Question 16

Sxs deep vein thrombophlebitis

Answer 16

• may be asymptomatic early; progressive inflammation with tenderness to palpation dull ache, tightness, or pain in the calf; swelling, warmth, redness, or discoloration in the LE; prominent superficial veins

Question 17

Review wells criteria for DVT

Answer 17

p 264 of study guide

Question 18

Medical management for DVT

Answer 18

• anticoagulation therapy is used to prevent new clots from forming, precent the existing clot from getting larger, and stabilize the clot through anti-inflammatory properties (LMWH)
• pts who are at high risk for bleeding are given unfractionated heparin (UFH)
• both LMWH and UFH are associated with heparin-induced thrombocytopenia
• graded compression stockings

Question 19

what is HIT (heparin induced thrombocytopenia) associated with

Answer 19

a paradoxical increased risk for venous and arterial thrombosis

Question 20

Homan’s Sign

Answer 20

AKA dorsiflexion sign
- may still be used in clinics but is has low associated sensitivity and specificity values and alone it is not diagnostic of DVT

Question 21

Pulmonary embolism presentation

Answer 21

• presents abruptly with chest pain and dyspnea, also diaphoresis, cough, and apprehension; requires emergency treatment

Question 22

PE mortality

Answer 22

• 20% with acute PE die almost immediately; 40% die within 3 months

Question 23

what can PE result in

Answer 23

• chronic thromboembolic pulmonary hypertension with reduced oxygenation and pulmonary hypertension
• can lead to right heart dysfunction and failure

Question 24

What is chronic post-thrombotic syndrome

Answer 24

• a combination of clinical signs and symptoms that persists after LE DVT
• thrombosis resolution is incomplete

Question 25

Sxs of chronic post-thrombotic syndrome

Answer 25

• pain, intractable edema, limb heaviness, skin pigmentation changes, and leg ulcers

Question 26

what does chronic post-thrombotic syndrome lead to

Answer 26

reduced quality of life and impaired functional mobility

Question 27

chronic venous stasis/incompetence

Answer 27

• venous valvular insufficiency: from fibroelastic degeneration of valve tissue, venous dilation

Question 28

chronic venous stasis/incompetence Classification

Answer 28

• Grade I: mild aching, minimal edema, dilated superficial veins
• Grade II: increased edema, multiple dilated veins, changes in skin pigmentation
• Grade III: venous claudication, severe edema, cutaneous ulceration