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CPR 2 Exam 1 > Peripheral Artery Disease > Flashcards

Peripheral Artery Disease Flashcards

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1
Q

What carotid artery stenosis?

A

Stenosis of the internal carotid artery

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2
Q

Is the ischemia in carotid artery stenosis reversible?

A

Yes

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3
Q

What may happen with reperfusion after ischemia?

A

Additional emboli or stroke

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4
Q

What are most ischemic strokes due to?

A

Emboli from the heart

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5
Q

Symptoms of ischemic cerebrovascular disease are predominantly due to what?

A

Emboli

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6
Q

Which artery do emboli typically arise from?

A

Proximal internal carotid artery

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7
Q

What artery is particularly prone to atherosclerosis?

A

Proximal internal carotid artery

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8
Q

What are symptoms of carotid artery stenosis?

A

Amaurosis fugax
Transient ischemic attacks
Ischemic stroke on the same side as lesion

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9
Q

What determines how carotid artery stenosis is treated by carotid endarterectomy?

A

Patient’s risk for TIA or stroke

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10
Q

What are risk factors for carotid artery stenosis?

A 
HTN
Heart disease
Smoking
Older age
Male sex
Hypercholesterolemia
DM
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11
Q

What are the two categories of carotid artery stenosis?

A

Asymptomatic

Symptomatic

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12
Q

What are indications for a carotid ultrasound?

A

Cervical bruit

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13
Q

What is the sensitivity and specificity for detection of > 70% stenosis with carotid duplex ultrasonography?

A

Sensitivity: 90%
Specificity: 94%

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14
Q

Does screening for bruit on physical exam have good reliability and sensitivity?

A

No

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15
Q

What does the aorta of a healthy young man measure?

A

2cm

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16
Q

When is an aortic aneurysm considered present?

A

Greater than 3cm

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17
Q

What percent of abdominal aortic aneurysms originate below the renal arteries?

A

90%

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18
Q

Which arteries are involved in abdominal aortic aneurysm?

A

Aortic bifurcation

Common iliac arteries

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19
Q

What are aortic aneurysms most often associated with?

A

Atherosclerosis

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20
Q

What is aortic dissection most often associated with?

A

HTN

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21
Q

What are inflammatory aneurysms?

A

Have inflammatory peel

Surrounds the aneurysm and encases adjacent retroperitoneal structures such as the duodenum and the ureters

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22
Q

What are clinical findings seen with ruptured aneurysms?

A

Severe pain
Palpable abdominal mass
Hypotension
Free rupture into the peritoneal cavity is lethal
Most aneurysms have a thick layer of thrombus lining the aneurysmal sac

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23
Q

Is embolization in the lower extremities seen with aortic aneurysms?

A

No

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24
Q

Is hematocrit normal in abdominal aneurysms?

A

Yes

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25
What other disease are concomitant with abdominal aneurysm?
Coronary artery disease Carotid disease Kidney impairment Emphysema
26
What is the diagnostic study of choice for initial screening for abdominal aneurysm?
Abdominal ultrasonography
27
Who is abdominal ultrasonography good for screening abdominal aneurysms?
65-75 year old men
28
Who is abdominal ultrasonography bad for screening abdominal aneurysms in?
Women with a history of smoking
29
What is seen on abdominal or back radiographs with abdominal aneurysms?
Curvilinear calcifications outlining portions of aneurysm wall
30
When is emergency repair possible in aortic aneurysms?
Blood in contained to the retroperitoneum
31
Is surgery indicated in inflammatory aneurysms?
No (unless retroperitoneal structures are compressed)
32
Where is the graft sutured in abdominal aneurysms?
Above aneurysm and below aneurysm
33
How is endovascular repair done in abdominal aneurysms?
Line the aorta and exclude the aneurysm
34
Which type of abdominal aneurysm needs additional interventions?
Endovascular repair
35
When should a CT scan be ordered for abdominal aneurysm?
When near 5.5cm for treatment
36
What is the most common peripheral artery occluded by atherosclerosis?
Superficial femoral artery
37
What ethnicities are most impacted by superficial femoral artery atherosclerosis?
Blacks | Hispanics
38
What arteries are also sometimes occluded and result in short-distance claudication?
Common femoral artery | Popliteal artery
39
What intermittent claudication symptoms in the common femoral, superficial femoral, and popliteal artery are confined to what?
Calf
40
When does claudication happen?
Occurs at 2-4 blocks when there is occlusion or stenosis of the superficial femoral artery provided there are good collaterals
41
What is seen with short-distance claudication?
Dependent rubor of the foot with blanching on elevation
42
What does chronic low blood flow states cause?
Atrophic changes in the lower leg and foot with loss of hair Thinning of the skin and cutaneous tissues Disuse atrophy of the muscles
43
What is seen with segmental occlusive disease of the femoral artery?
Common femoral pulsation normal | Popliteal and pedal pulses are reduced
44
Where does claudication typically occur?
Legs during exercise and disappears with rest
45
What is peripheral artery disease associated with?
``` Increased mortality Limited exercise tolerance Chronic ischemic ulcers Susceptibility to infection Need amputation ```
46
Is ankle-bachial indices recommended for asymptomatic patients?
No
47
Ankle-brachial indices predicts what more accurately than is possible using history and PE alone?
Angiography results
48
What is the ABI cutoff for patients with suspected PAD?
<0.9
49
How do you calculate right ABI?
Higher right ankle pressure/Higher arm pressure (right or left)
50
How do you calculate left ABI?
High left ankle pressure/Higher arm pressure (right or left)
51
What do ABI levels below 0.4 suggest?
Chronic limb-threatening ischemia
52
What do ABI readings depend on?
Arterial compression
53
When can ABIs be misleading?
Calcification due to DM, CKD, older adults
54
What is used instead of ABI in special patients?
Toe-brachial index (0.7 diagnose PAD)
55
What imaging is done for PAD if revascularization is planned?
Duplex ultrasonography CT angiography MR angiography
56
What is the medical and exercise therapy for PAD?
High-dose statin | Exercise treatment
57
What is the surgical treatment for PAD indicated?
Claudication is progressive, incapaciting, or interferes with daily life
58
When is surgical treatment for PAD mandatory?
Ischemic rest pain or ischemic ulcers threaten the foot
59
When is bypass surgery done?
Lesions of the superficial femoral artery done with femoral-popliteal bypass with autologous saphenous vein
60
When is endovascular surgery done?
Angioplasty/stenting of superficial femoral artery
61
Does endovascular have a lower morbidity than bypass?
Yes
62
Does endovascular surgery last longer than bypass surgery?
No
63
What is thromboendarterectomy?
Removal of arterosclerotic plaque is limited to the lesions of the common femoral and profunda femoris arteries
64
What antiplatelet drugs are used in PAD?
Aspirin | Clopidogrel
65
What do aspirin and clopidogrel do for PAD?
Reduce risk of MI, stroke, and vascular death
66
What two drugs are used exclusively for PAD?
Cilostazol | Pentoxifylline
67
What is cilostazol?
PDE3 inhibitor | Increases exercise tolerance in patients with severe claudication
68
What is Petoxifylline?
Xanthine derivative | NOT RECOMMENDED
69
What are the risk factors for PAD?
Age less than 50 with DM (smoking, dyslipidemia, HTN, homocysteinemia) Age 50-69 with hx of smoking or DM Age > 65 Abnormal lower extremity pulses Leg symptoms with exertion or ischemic rest pain Known coronary, carotid, or renal atherosclerosis
70
What is the leading cause of lower extremity wounds and amputations?
PAD
71
What are the screening tips for PAD?
Patient has risk factors for PAD (thus CVD) or symptoms of claudication suggestive of PAD Screen with ABI If negative, still suspicion for PAD Perform exercise stress test with post-exercise ABI
72
What is a severe manifestation of venous HTN?
Chronic venous insufficiency
73
What is a complicating factor of venous lower extremity disease?
Obesity
74
What is a common cause of venous lower extremity disease?
Progressive superficial venous reflux
75
What is seen in lower extremity disease (venous)?
Edema Skin pigmentation Subcutaneous lipodermosclerosis in lower leg Large ulceration at/above medial ankle (venous ulcer)
76
Patients often have a history of what in chronic venous insufficiency?
``` DVT Leg injury (trauma or surgery) ```
77
Stasis dermatitis is common in what?
Chronic venous insufficiency
78
What is the yellow color seen in chronic venous insufficiency?
Lipodermosclerosis
79
What is the dark color seen in chronic venous insufficiency?
Hermosiderin deposition as fluid leaks into the tissues and when it leaves it leaves heme pigments behind
80
What are the clinical findings with chronic venous insufficiency?
Progressive pitting edema Subcutaneous changes Itching Dull discomfort (worse with standing) Pain with ulceration Skin at ankle is taut from swelling, shiny, brown pigment SubQ tissues become thick and fibrous Ulcerations occur at or above ankle medial/anterior Healing results in thin scar on a fibrotic base that breaks down with minor trauma Varicosities appear Cellulitis
81
How is cellulitis diagnosed?
Blanching erythema with pain
82
Patients with post-thombotic syndrome or signs of chronic venous insufficiency should undergo what?
Duplex ultrasonography to determine whether superficial reflux is present and to evaluate the degree of deep reflux and obstruction
83
What is the most common scenario in chronic venous insufficiency?
Elderly female with CVI Conservative treatment of compression stockings, rest with leg elevation did not help Next step is duplex ultrasonography to look for venous reflux to determine extent of disease and determine further treatment options
84
What are the general treatments for chronic venous insufficiency?
Compression stockings Avoid long periods of sitting or standing Pneumatic compression of leg (refractory cases)
85
Treatment of superficial vein reflex (varicose veins) has been shown to decrease the recurrence rate of what?
Venous ulcers
86
When should varicose veins not be removed?
Obstruction of femoral and popliteal deep venous system
87
What should be used to treat chronic iliac deep vein stenosis to improve venous ulcer healing and reduce the ulcer recurrence rate in severe cases?
Venous stents

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