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Flashcards in Peripheral Vascular Disease Deck (46):
1

Equation for vessel flow

Q = ((P1-P2)πr^4)/8nL

2

Equation for vessel resistance

Proportional to nL/r^4

3

For stenoses of the same length and radius, what factor will cause the biggest pressure drop across the stenosis?

Higher flow

4

Flow in terms of area and velocity

A1V1 = A2V2

5

Graph of cardiac cycle and arterial flow

Look at lecture this seems important

6

High resistance arteries

Muscular arteries (arm, leg)
Mesenteric arteries (pre-prandial)

7

Low resistance arteries

Internal carotids, vertebrals, renals, mesenteric arteries (post-prandial)

8

Two factors that affect pressure in peripheral veins?

Muscular contraction and respiration.

9

Three characteristics of normal venous waveforms

Display respiratory phasicity
Augment with calf muscle compression
Display valvular integrity (no retrograde flow on valsalva or increased intra-thoracic pressure).

10

Paradigm of atherosclerosis

A systemic disease that manifests locally.

11

What is peripheral artery disease

Atherosclerosis of the aorta, iliac, and lower extremity arteries. Regardless of symptoms, patients with PAD have a 3x increase in CV events.

12

What are two factors that contribute to PAD development?

Smoking and diabetes.

13

Intermittent Claudication

Pain or fatigue in calf, thigh, buttock, or lower back that occurs with exertion and is relieved by rest. Location of symptoms corrlates with the level of obstruciton (generally one level below the disease)

14

Critical limb ischemia

Pain or parathesia in the lower extremity at rest. Exacerbated by leg elevation and relieved with dependency on gravity. Can have ulceration with severe ischemia

15

Leriche Triad of aortoiliac occlusion

Bilateral buttock/thigh claudication, impotence, and global atrophy

16

What are the most commonly involved arteries in PAD?

Femoral/popliteal area. Then tibeal/peroneal area, then aortoiliac area.

17

What area of PAD involvement is hardest to treat? Easiest?

Hardest is tibeal/peroneal. Easiest is aortoiliac.

18

What area of PAD is affected in DM?

Tibeal/peroneal

19

5 year outcomes of PAD?

Most with stable claudication. However, many with CV related morbidity and mortality.

20

How to detect PAD?

Best way is the ankle/brachial index. Performed at rest and with exercise. Also leg imaging

21

How to conduct ankle brachial index?

Take highest ankle systolic bp (right or left) and divide by highest brachial systolic bp (right or left).

22

What is normal ABI? What is severe obstruction? What if ABI is greater than normal?

Normal ABI is .9-1.4. Severe obstruction is 1.4, then calcification

23

Normal vs obstructed arterial pulse waveforms

Normal has rapid upstroke and dicrotic notch.

Obstructed has delayed rise, rounded peak, convex decay..

24

Why treat PAD?

Primarily to reduce CV events, then to improve symptoms

25

How to treat PAD

1) stop smoking, control BP w/ace inhibitor, control lipid with statins, control platelet aggregation with aspirin/clopidogrel

2) Walking, treat with cilostazol, revascularize

26

Sources of acute arterial occlusion

In situ thrombosis (plaque rupture), embolism, trauma, vasculitis, severe venous thrombosis

27

Signs of acute limb ischemia

6P's

Painful, pulseless, paralyzed, parathesias, pallor, poikilothermia.

Symptoms lasting less than 2 weeks.

28

Thromboangitis obliterans

AKA buerger's disease

Segmental inflammation of medium sized arteries AND veins in 2 or more limbs. This causes thrombosis and vasospasm.

Not related to atherosclerotic disease.

29

What causes Thromboangitis obliterans

Tobacco is the leading precipitant and it occurs in men>women, less than 40.

30

Symptoms of Buergers disease

Triad: Raynaud's phenomenon (vasospasm), superficial thrombophlebitis (swelling of vein due to blood clot), distal arterial occlusion causing ulceration.

31

Imaging of thromboangitis obliterans

Alternating areas of stenosis, occlusion.

Corkscrew collaterals.

32

Raynaud's Phenomenon

Vasospasm causing occlusion. 3 stages 1)pallor, 2)cyanosis, 3)rubor

33

Raynaud's Disease vs Raynaud's Phenomenon

Disease: Must be bilateral and present for at least 2 years without an identifiable secondary cause. Females>Males. Ulceration is rare.

Phenomenon: Secondary to diseases

34

Two types of venous thrombosis

Superficial thrombophlebitis and deep vein thrombosis

35

Symptoms of venous thrombosis

Leg pain, erythema, edema, palpable cord in vein

36

Virchow's Triad

Triad of things that lead to thrombosis

1) Hypercoagulable state
2) Stasis of Blood
3)endothelial injury

37

Chronic venous insufficiency

Valve incompetency that doesn't allow for regular venous return back to heart. Occurs with valsalva

38

DVT waveform

Distal veins will lack respiratory phasicity and distal veins will not augment blood flow. Non compressible

39

Risk of PE and where DVTs occur

Risk of PE increases when DVT is proximal, but DVTs happen more commonly in distal veins

40

PE symptoms

SOB, chest pain, hemoptysis, tachycardia, hypoxia

41

Massive vs Submassive PE

Massive has RV strain with hemodynamic compromise like syncope/cardiac arrest, respiratory failure

Submassive has RV strain w/o hemodynamic compromise. Normal BP

42

Signs/Sxs of chronic venous insufficiency

Swelling, pain, skin flaking, varicose veins. Atrophie Blanche, stasis pigmentation.

43

Acute Lipodermatosclerosis

Inflammatory response to excess interstitial fluid that comes from venous insufficiency. Often mistaken for infectious cellulitis. Does not respond to antibiotics. Compression is key

44

Lipedema

Disproportionate fat deposition in lower half of body. Ankle cut off sign. Bilateral/symmetric, non-pitting and tender. Anterior lateral malleolal fat-pad sign

45

Lymphedema

Begins distally and involves the dorsum of the foot (buffalo hump). Pathognomonic for lymphedema is Stemmer's sign which is the inability to pinch the skin at the base of the second toe. Lichenification can occur.

46

Stemmer's sign

Inability to pinch the skin at the base of the second toe. Pathognomonic for Lymphedema