Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

R9 > Chapter 105 - Lower extremity arterial disease - medical management and decisions > Flashcards

Chapter 105 - Lower extremity arterial disease - medical management and decisions Flashcards

1
Q

PAD prevalence overall and age distributed

A

4.3% 40-49 years: 0.9% 50-59 years: 2.5% 60-69 years: 4.7% >69 years: 14.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

5 years course of intermittent claudication

A

amputation 1-7% deterioration 25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CLTI cardiovascular mortality in 1, 5 and 10 years

A

1 year: 12% 5 years: 42% 10 years: 65%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chronic subclinical LE ischemia definition

A

ABI < 0.9 without IC or CLTI usually due to limitation of other comorbidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ambulation rate of decline in I.C.

A

8.4 m/yr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Structured exercise survival benefit in 5 years

A

80.5% vs 56.7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ACC/AHA recommendation on exercise

A

30-45 min x 3-4/week for 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Percentage of patients with I.C. where exercise therapy can be completed

A

1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Two FDA approved drugs for PAD

A

1) Pentoxifylline (Trental) 2) Cilostazol (Pletal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cilostazol MOA

A

Phosphodiesterase III inhibitor –> increase cAMP 1) SMC relaxation 2) inhibit platelet aggregation 3) decrease SMC proliferation 4) decrease TG, increase HDL 5) increase VEGF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Effect of cilostazol

A

1) increase walking distance by 50% 2) increase quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Side effects of cilastazol

A

1) headache 2) diarrhea and other GI symptoms 3) CHF exacerbation 4) interact with cytochrome p450 system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Contraindication of cilastazol

A

CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dose of Cilostazol

A

100 mg po BID start slow titrate up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cilostazol vs pentoxifylline

A

Cilostazol better at increasing walking distance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

TASC definition

A

Trans Atlantic Inter Society Consensus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

TASC purpose

A

1) gauge extent of angiographic disease 2) aid in decision making

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What % of CLTI post-op bypass does not show clinical improvement despite graft patency

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Specific names of QOL PAD surveys

A

1) SF36 2) Nottingham Health Profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Endpoint in I.C. treatment

A

Quality of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Endpoint for CLTI based on Taylor et al in Rutherford class 5/6 bypass success

A

1) Patent until wound heal 2) Limb salvage 1 year 3) ambulatory 1 year 4) survival 6 months Total probability 44%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

TASC and TASC II years

A

TASC 2000 TASC II 2007

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Run off score

A

0 < 20% stenosis 1: 20-50% stenosis 2: 50-99% stenosis 2.5: < half occluded 3: > half occluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Calcium score in PAD anatomy

A

0: none 1: < 25% 2: 25-50% 3:> 50% circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Lesion length category

A

Short < 6cm Intermediate 7-10cm Long > 10cm

26
Q

I.C. risk of amputation per year and cardiac death

A

Amputation 1% Cardiac death 3-5%/year

27
Q

Smoking cessation in I.C.

A

1) unclear if increases walking distance 2) reduces cardiovascular events

28
Q

Cilostazol cannot be used in this % of population and why

A

15% CHF

29
Q

ACC/AHA guideline for treatment of PAD

A

1) antiplatelet 2) cilostazol Class I evidence

30
Q

CLEVER study on PAD

A

Claudication: exercise vs endoluminal revascularization 6 month: walking time best in exercise > stent > drugs QOL: best in stent > exercise > drugs

31
Q

Amputation in I.C. patients post-op from revasc attempt

A

1.6% in 1 year

32
Q

Medical therapy only in PAD effectiveness

A

30%

33
Q

Johnson characteristics most ammenable to perc endo treatment

A

1) focal lesion 2) large diameter 3) adequate outflow

34
Q

CIA angioplasty patency in 5 year

A

70%

35
Q

% of IC that progress to CLTI

A

< 5%

36
Q

Typical CLTI symptom duration and pressure measurement for diagnosis

A

2 weeks of symptoms Ankle pressure < 50 toe pressure < 30

37
Q

CLTI outcomes in amputation and death 1 year

A

25% amp 25% death

38
Q

Medical treatment only in CLTI amp rate

A

40% amputation at 6 months

39
Q

Decision in CLTI

A

1) medical vs intervention 2) amputation vs revasc 3) endo vs open

40
Q

Rate of primary amputation in CLTI

A

10-40%

41
Q

Unreconstructable CLTI rate

A

60%

42
Q

Factors that increase BKA healing

A

1) well-controlled comorbidities 2) palpable femoral 3) warm calf 4) no infection

43
Q

Immediate post-op prosthesis benefits

A

1) reduce revision (5.4 vs 27.6%) 2) 86% independent amublation rate 3) time to ambulation 15.2 days

44
Q

BASIL trial on 1 year amputation-free survival in bypass vs endo then bypass

A

Endo then bypass 40% Primary bypass 70%

45
Q

Situational perfusion enhancement

A

For healing wounds temporarily

46
Q

BASIL key points

A

1) 450 patients randomized to bypass vs POBA 2) 6 months AFS 21 vs 26% 3) 2 year surgery is better in AFS and survival

47
Q

BASIL 2

A

vein bypass vs best endo 600 patients primary outcome: amputation free survival

48
Q

BEST CLI

A

best endo vs best surgery 2100 patients primary outcome: MALE

49
Q

Mortality following LE bypass

A

1.8%

50
Q

Cardiac complication following LE bypass

A

7.2%

51
Q

Angiogenesis for CLTI possibilities

A

1) VEGF 2) HGF 3) stem cell

52
Q

Other research in CLTI

A

1) Hypoxia inducible factor pathway stimulation (prolyl-4-hydroxylase inhibitor, thioredoxin system, peroxome proliferator activated receptor gamma coactivator 1 alpha protein, micro RNA, oligonucleotide) 2) therapeutic ultrasound 3) immune modulation 4) viral gene transfer 5) antibiotic therapy 6) cell-free oxygen delivery vectors

53
Q

Decision tree analysis in revascularization of CLTI

A

1) revascularization vs primary amputation gives 1.1 QALYs 2) revascularization vs medical only gives 1.2 QALYs gain 3) revascularization least costly per QALY if 1 month patency > 11%

54
Q

TASC C lesion decision tree

A

Stent if 1) primary patency > 32% in 5 years 2) age > 80 3) mortality periop of bypass > 6%

55
Q

Pharmacologic treatment of claudication part 1

A
56
Q

Pharmacologic treatment of claudication part 2

A
57
Q

CLTI endpoints different types and definitions

A
58
Q

Taylor’s probability of failure after bypass when clinical condition is present

A

2 factors: 33% success

3 factors: 10% success

all 4 factors: 5% success

hyperlipidemia doesn’t count

59
Q

TASC II aorto-iliac lesions

A
60
Q

TASC II femoropopliteal lesions

A
61
Q

Morbidity after bypass surgery

A
62
Q

Comparison of different risk stratification scores in cardiovascular disease and PAD

A

R9 (200 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions