PAD/PVI

Question 1

Peripheral Artery Insufficiency / Disease

Answer 1

Peripheral arterial insufficiency results when there is insufficient blood flow to the extremities; it includes disease of the aortoiliac, femoropopliteal, and intrapopliteal arterial segments. It is much more likely to occur in the lower extremities,

Question 2

Major cause of PAD

Answer 2

Atherosclerosis

Question 3

PAD Risk Factors

Answer 3

65+ years old

50-64 year old with diabetes, smoking, hyperlipidemia, HTN, family history

Question 4

PAD Symptoms

Answer 4

Can be unique to each patient in how they describe the pain

Question 5

Key of PAD Symptoms

Answer 5

Claudication - cramping or tightening of the vessels causing pain in the limbs during exercise / use that is relieved at rest

Question 6

PAD Symptoms

Answer 6

Claudication
Muscle, hair, or skin changes in the limbs indicating circulation compromise
Dependent rubor (elevation of limb results in paleness)

Question 7

PAD Diagnosis

Answer 7

History and Exam

Resting ABI - use dopler and BP cuff to measure pressure at which pulse is lost, significant difference between legs (0.9 or less) is suggestive.

Duplex ultrasound may also be used

Question 8

ABI values

Answer 8

<0.9 = PAD
<0.75 = claudication
<0.5 = tissue loss

> 1.4 = clacification of vessels, refer to specialist

Question 9

PAD and Diabetes

Answer 9

diabetic neuropathy can make diagnosis more difficult, may mask claudication pain

Question 10

PAD Management

Answer 10

Depends of symptom severity
Lifestyle modifications
Structured exercise program
Higher risk patients need anti platelet therapy, HTN management, DM management

Question 11

PAD referral

Answer 11

signs of vascular compromise
ABI <0.5
Non-healing ulcers

Refer diabetic patients to podiatry

Question 12

Acute Arterial Insufficiency

Answer 12

Medical emergency
Sudden onset of symptoms of limb ischemia

If history of A-Fib or CVA, consider embolus
If history of vascular disease, consider acute thrombosis

Question 13

Blue-Toe syndrome

Answer 13

Bluish discoloration of feet or other signs of vascular loss in foot

results from microemboli from the heart, aorta, or peripheral arteries that are small enough to lodge in the capillaries

Ultrasound and consult

Question 14

Peripheral Venous Insufficiency

Answer 14

Peripheral venous insufficiency occurs whenever there is obstruction to venous return in the superficial or deep veins of the upper or lower extremities. Important clinical syndromes related to venous insufficiency include DVT, venous stasis, varicose veins, stasis dermatitis, and leg ulceration.

Question 15

DVT

Answer 15

Blood clot in the deep veins, usually lower limbs

Question 16

Phlebitis

Answer 16

preferred term for a superficial venous thrombus that has no risk of becoming a PE

Usually a result in superficial veins and not the deep veins

Question 17

DVT Presentation

Answer 17

Non-specific, history and exam are key

Leg edema with calf tenderness is the classic presentation

Question 18

Homan’s Sign

Answer 18

Calf pain on dorsiflexion of the foot, may suggest DVT

Question 19

SVT Symptoms

Answer 19

superficial edema, erythema, tenderness over a superficial vein

Question 20

SVT Management

Answer 20

NSAIDs
Limb elevation and compression
Heparin may be considered if concerned about DVT as well

Question 21

Chronic Venous Stasis

Answer 21

Chronic venous stasis results from increased pressure in the deep veins. This condition produces edema, varicose veins, chronic skin changes, and potentially ulceration.

Managed with compression stockings

Question 22

Venous Stasis Presentation

Answer 22

The clinical appearance of chronic venous stasis varies according to whether the superficial or deeper veins are affected. Chronic edema and skin discoloration on the legs and ankles may be present. Varicose veins, ulceration, and even cellulitis may result.

Question 23

Varicose Veins

Answer 23

Distension and proliferation of superficial veins

Primary - familia

Secondary - from previous DVT

Question 24

Varicose Vein Treatment

Answer 24

Support stockings

Severe can be referred to a specialist for ablation, laser therapy, etc.

Question 25

Venous Stasis ulcers

Answer 25

Ulcer above the medial malleolus and signs of stasis