Case of the week: Peripheral arterial disease Flashcards Preview

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Flashcards in Case of the week: Peripheral arterial disease Deck (15)
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1
Q

Why diagnose PAD if you aren’t going to perform an intervention?

A

it affects the long term cardiovascular health of the patient

**these patients are at increased risk of MI and strokes, and have decreased overall survival

2
Q

Some patients with PAD may be asymptomatic, while others have severe symptoms. What symptoms might you see in these patients?

A

severe ischemia leading to claudication and necrosis/tissue loss, atypical exertional leg pain

3
Q

Which artery/arteries are most likely to be occluded leading to PAD?

A

superficial femoral

**most commonly occluded artery in the body, damaged by cigarette smoking, can have few symptoms bc the deep femoral compensates

4
Q

What can cause intermittent claudication?

A

atherosclerosis
Buerger’s disease
vasculitis
fibromuscular disease

5
Q

Symptoms of PAD

A
fatigue, aching calves w exercise relieved by rest (classic)
hip and buttock pain
pain in toes
weakness/tiredness
non-healing ulcer
infection

**rubor because the capillaries are massively dilated to try to get blood to the foot

6
Q

What might you see on physical exam in PAD?

A
femoral bruits
diminished pulse
skin, hair, nail changes
dependent rubor, pallor with elevation
ulceration
7
Q

What are some symptoms of blood return (vein) problems?

A

swelling
varicose veins
pain at the end of the day

8
Q

How do you measure ABI?

A

take BP in both arms and at both ankles; ABI(R) use highest right foot BP/highest arm BP; ABI(L) use highest left foot BP/highest arm BP

  • *normal is between 1.01 and 1.30
  • *if ABI is higher than 1.3, suggestive of calcified vessels
9
Q

What other tests might you order after the ABI if you are thinking about doing an intervention?

A

arterial duplex
segmental pressures
angiogram **gold standard for diagnosis

10
Q

If you have “one level” of disease, or one block in vasculature, what might your ABI be like? Two levels? Three levels?

A
  1. 6-0.8
  2. 3-0.6

<0.3

**should be greater than 0.1

11
Q

T/F: In PAD, you always hurt one level below the blockage

A

True

ex: if blockage in aortic/iliac segment, might present with pain in thigh/butt

12
Q

What are indications for intervention in PAD?

A

Lifestyle limiting claudication?
Unresponsive to medical therapy?
Do they have rest pain?
Do they have tissue loss/a non-healing ulcer?

  • *don’t treat asymptomatic or minimally symptomatic disease
  • *with a stent or bypass graft, their risk of adverse events actually becomes worse!
13
Q

This artery is easy to open up & perform an intervention on (if patient is having symptoms, might be easy to fix); this artery is more challenging to perform an intervention on

A

iliac artery; superficial femoral artery

14
Q

What can be done to help relieve symptoms of claudication in PAD?

A

Cilostazol (makes RBCs more “slippery”)
supervised exercise therapy (walk until you begin to have symptoms, walk a bit further, stop & rest, then begin to walk again)

15
Q

Types of medical therapy for PAD

A

antiplatelet therapy (ASA)
lipid management: initiate statin therapy w moderate potentcy stain in pts greater than 75 and high potency in patients less than 75
blood pressure management
diabetes management