PAD

Question 1

What are the 2 types of PAD?

Answer 1

Atherosclerotic and Nonatherosclerotic

Question 2

What is the leading cause of PAD in pts >40 yo?

Answer 2

Atherosclerosis

Question 3

What are other causes of PAD?

Answer 3

Thrombosis, Embolism, Vasculitis, Fibromuscular Dysplasia, Entrapment, and Trauma

Question 4

What is the most modifiable risk factor of PAD?

Answer 4

Cigarette Smoking

Question 5

What are large risk factors for PAD?

Answer 5

DM, Hypercholesterolemia, HTN, Hyperhomocycsteinemia

Question 6

What are the most common sites of PAD?

Answer 6

Aorta/Iliac, tibial/peroneal, femoral/popliteal(Most Common) arteries

Question 7

What is the most common Sx of PAD? Where does it occur? When does it occur? How to you relieve it?

Answer 7

Claudication –> include pain, ache, cramp, numbness, and muscle fatigue. Sx of claudication are DISTAL to the site of lesion. It occurs during exercise/activity. Relieved with REST

Question 8

What Sx’s are associated with severe PAD?

Answer 8

Hair loss, Thickened nails, smooth/shiny skin, reduced Temp, Pallor and cyanosis.

Question 9

What is the ABI (Ankle:Brachial Index)? What MAY the values indicate? What do you use in addition to ABI?

Answer 9

Noninvasive testing in which a BP ratio from arm is compared to lower extremity. Normal >1; <.5 may indicate severe PAD.

You also want to do a waveform analysis with Doppler U/S. This can show you the extend of PAD and where it is.

Question 10

When would you use a MRA or CTA?

Answer 10

Serious cases that you may suspect need revascularization.

Question 11

Aortoiliac AD shows Sx where? What is Tx? When do you refer them?

Answer 11

Sx occur in calves, thighs, or buttocks. Tx is conservative or surgical based on severity. Refer when walking distance is reduced or it is limiting their ADLs.

Question 12

What is most common artery affected in Femoral/Popliteal AD? What change occurs in Femoral Pulse? What are m/c Tx? When do you refer?

Answer 12

Superficial Femoral Artery. No change in Femoral Pulse. Bypass surgery is most common, but Thromboendarterectomy is used, but limited to common femoral artery Dz. Refer when Sx progress, short distance Claudication, ulcerations, or rest pain.

Question 13

What is the m/c vessels involved in leg/foot AD. What is a major risk factor for it? What is goal of Tx for it? What happens to pedal pulses? When to refer?

Answer 13

Tibial Vessels; DM is MAJOR risk factor; Tx goal is to prevent tissue loss. Pedal Pulses may be decreased or absent; See previous and if ulcerations are present

Question 14

What are the conservative Txs for all pts with PAD?

Answer 14

SMOKING CESSATION; Control BP in HTN; Lower Cholesterol; Weight Loss; Treat DM aggressively. Keep feet clean and wear shoes. **DO NOT use compressive stockings.

Question 15

What are the NON atherosclerotic PADs?

Answer 15

Fibromuscular Dysplasia
Beurger’s Dz (thromboangitis Obliterans)
Vasculitis - Takayasu’s Arteritis and Giant Cell Arteritis

Question 16

What size arteries does Fibromuscular Dysplasia affect? Which are most common? Who does it usually affect? What is the Classic Sign?

Answer 16

Medium to Small Arteries
Renal and Carotid Arteries
Women >50 yo
“String of Beads” on angiography.

Question 17

What else is thromboangitis obliterans called? What does it typically affect? Who does it typically affect? What is main cause of it?

Answer 17

• Buerger’s Dz
• Affects small/medium arteries; DISTAL upper/lower extremities
• Men >40; More common in Asians and E. European
• Cigarette Smoking is main cause

Question 18

What is TRIAD of Buerger’s Dz (thromboangitis obliterans)? How is diagnosis confirmed? What is Tx?

Answer 18

• Claudication of affected extremity; Migratory superficial vein thrombophlebitis; and Raynaud’s Phenomenon
• Dx confirmed with biopsy
• No specific Tx except Smoking Cessation

Question 19

What size arteries does Takayasu’s Arteritis affect? Who does it affect most commonly?

Answer 19

• inflammation and stenosis of large/medium arteries

- Most common in adolescent girls and young women. Most common in Asians

Question 20

When would you suspect Takayasu’s Arteritis? What is the Tx?

Answer 20

• Suspect in young women who develop decreased or absent pulses, BP changes, or bruits.
• Tx- glucocorticoid therapy may alleviate acute Sx; However, Surgery to decrease mortality rate

Question 21

What else do they call Giant Cell Arteritis? What artery(s) are typically involved? Who does it occur in almost exclusively

Answer 21

• “temporal arteritis”
• Branches of Carotid, but ESPECIALLY temporal artery
• Seen exclusively in pts >50 yo

Question 22

What are Sx of Giant Cell Arteritis? How do you confirm the Dx of it? What is Tx?

Answer 22

• Sx include fever, anemia, high ESR, and HA’s, fatigue, etc.
• Dx confirmed by Biopsy
• Tx is Glucocorticoids. High dose prednisone for 1 mo, followed by tapering

Question 23

What are the arterial blood vessel disorders?

Answer 23

• Acute Arterial Occlusion of Limb
• Thoracic Outlet Compression Syndrome
• Peripheral Artery Aneurysm
• Raynaud’s phenom
• Acrocyanosis
• Livedo Reticularis
• Chilbain’s Syndrome