Peripheral Vascular Disease

Question 1

What are peripheral vascular diseases?

Answer 1

Atherosclerotic disease of non-cardiac,

arteries

Question 2

What are peripheral vascular disease risk factors the same as?
Except for what? (2)

Answer 2

same as for CAD,

except that cigarette smoking
and diabetes mellitus appear to
increase the risk of PVD

Question 3

Peripheral vascular disease can effect what locations? 4

Answer 3

GI tract, GU tract, brain,

extremities

Question 4

What is pathogenesis in peripheral vascular disease?

Answer 4

vessel occlusion by atherosclerotic plaques
with “downstream” ischemia and
necrosis

Question 5

GI involvement in peripheral vascular disease can occur with what? (2)

Answer 5

1. occlusive atherosclerosis of the celiac or mesenteric arteries
2. atherosclerotic emboli from the aorta (cholesterol emboli)

Question 6

If you have occlusion in GI, where and what changes do you see?

Answer 6

ischemic changes and/or infarction
of the bowel “downstream” from the
occlusion

Question 7

Ischemic changes in the colon can lead to what?

3 symptoms

Answer 7

ischemic colitis

1. atrophy of surface epithelium,
2. hyalinization/fibrosis of the lamina propria
3. diarrhea that can be bloody

Question 8

What people should you look for PVD causing ischemic colitis?

Answer 8

Elderly with athersclerosis factors

Question 9

Infarction of the bowel can cause what?

Answer 9

1. ileus
2. severe abdominal pain
3. bloody diarrhea

Question 10

Can infarction of bowel by fatal?

Why?

Answer 10

Yes

Bacterial overgrowth

Question 11

How do you recognize infarction of bowel? (3)

Answer 11

1. High level of suspicion
2. Abomdinal pain out of proportion to physical exam
3. Metabolic acidosis

Question 12

What GU organs are involved in PVD?

Answer 12

1. kidneys

2. male erectile tissues

Question 13

3 renal effects of PVD?

Answer 13

1. Occlusion of renal arteries –> Decreased perfusion –> Activate RAS
2. HTN injuries
3. Renal infarctions

Question 14

Effect on male erectile tissue in PVD?

Answer 14

Male erectile dysfunction (impotence)

Question 15

PVD of carotid arteries is a significant caues of what?

Answer 15

TIA’s

Strokes (CNS infarcts)

Question 16

Are TIA’s and strokes associated with emboli or occlusion?

Answer 16

Emboli

Question 17

Progressive occlusion can lead to what with carotid arteries?

Answer 17

Collateral formation

Question 18

Can a complete occlusion of coronary artery have no effects?

Answer 18

yes due to circle of willis

Question 19

Disease similar to coronary arteries in PVD can occur where?

Answer 19

Posterior portion of circle of willis via the basilar artery

Question 20

Partial occlusion in carotid arteries have what effects though?

Answer 20

1. Hypotensive

2. Injure CNS in sensitive areas

Question 21

What arteries are most affected by Partial occlusion of carotid arteries?

Answer 21

Middle cerebral arteries

Question 22

Treatments of carotid artery PVD? 3

Answer 22

Treatment of atherosclerosis in general
Anti-platelet therapy (ASA)
Surgical intervention (carotid endarterectomy)

Question 23

What chronic changes can be seen in PVD in extremities? 6

Answer 23

skin atrophy,
fatty replacement of muscle (muscle atrophy),
delayed wound healing,
claudication,
ulceration
eventual necrosis (dry gangrene) with secondary
infection (wet gangrene)

Question 24

Acute occlusion of larger vessels causes what? 2

Answer 24

Acute necrosis

Gangrene

Question 25

What is gangrene necrosis?

Answer 25

blood supply lost and tissue undergoes coagulative necrosis

Question 26

What is wet gangrene?

Answer 26

Superimposed bacterial infection results in coagulative necrosis being altered by liquefactive action of bacteria and attracted leukocytes

Question 27

In PVD, which is affected more, lower or upper extremities?

Answer 27

Lower

Question 28

Why are lower extremities affected more?

Answer 28

Abdominal atherosclerotic emboli can | shower both lower extremities

Question 29

What increases risk of lower extremity disease with PVD? (2)

Answer 29

Cigarette smoking and diabetes mellitus

Question 30

Diagnosis of PVD? 6

Answer 30

1. Claudication 2. Atrophy of skin and muscles 3. Diminished pulses 4. Ulceration 5. Vascular flow studies 6. Radiographic studies

Question 31

Treatment of PVD?

Answer 31

1. Treatment of general atherosclerosis 2. Anti-platelet therapies 3. Surgical and invasive radiology procedures

Question 32

6 surgeries to repair PVD?

Answer 32

```  Angioplasty +/- stents  ABF bypass  Fem-pop bypass  Fem-fem bypass  Axillary-fem bypass  Fem-distal bypass ```