Peripheral Vascular Disease Flashcards
(30 cards)
What is peripheral artery disease (PAD)?
Ahterosclerotic disease of the vessels outside the cardiac and CNS.
What is the most common presentation of PAD?
Intermittent claudication
Where is claudication experienced if there is PAD in the aortic bifurcation and/or common iliac?
buttock and hip (25-30% pts)
*Leriche’s Syndrome: 1) butt and hip claudication; 2) impotence; 3) decreased femoral pulses.
where is claudication experienced if in the common femoral?
thigh
Where is claudication experienced if blockage in the superficial femoral?
upper 2/3 calf (60%) cases
Where is claudication experienced if blockage in the popliteal?
lower 1/3 of the calf
where is claudication experienced if blockage in the dorsalis pedis/posterior tibialis?
foot
Who is high risk for DVT?
hypercoaguable states - pregnant, chemo
venous stasis - long plane ride, bedridden
What are the DDXs for leg pain?
- DVT
- PAD
- Neurospinal - disc disease/spinal stenosis
- neuropathic - DM/chronic EtOH abuse
- msk - OA or chronic compartment syndrome
What is the scoring chart for ABI?
systolic BP in legs> or equal to arms
> or equal to 1 = normal
0.5-0.9 = claudication
<0.5 = critical ischemia
What is Burger’s test?
- patient lying supine, lift legs to 45 degrees and look for pallor of the sole of the foot along with emptying of the dorsal foot veins
- have patient hang legs of the side of the bed in the presence critical limb ischemia, legs turn deep red “sunset foot” due to reactive hyperemia
What is the prevalence of PAD >55?
10-25% of the population
What percentage of PAD patients are asymp?
70-80%
What are the CVD/death risks associated with PAD?
same relative risk of death from CV causes as those with CAD or CVD.
4x as likely to die within 10 years as patients without disease
Prognosis at 1 year in patients with critical limb ischemia
alive with two lower limbs - 50%
amputation of one limb - 25%
cardiovascular mortality - 25%
what percentage of patients with PAD have atypical symptoms?
>50%
How do you tell PAD from pseudoclaudication?
What’s the Rx for PAD?
Drugs:
Cilostazol - Vasodilator +ADP inhibitor (increases RBC flex.)
Revascularization:
Severe inury
What are the major risk factors for carotid artery occlusion?
smoking
F>M
Age>65
What’s the most likely cause of chronic venous insufficiency?
DVT
What are the risk factors for AAA development?
Age >60
SMOKING
Males (5x)
caucasians:AAs (2:1)
hyperlipidemia
hypertension
What are the most common signs/sx of AAA?
older male with severe back or abdominal pain who presents with syncope or hypotension
tender, pulsatile mass
flank ecchymosis
How do you manage AAA?
> or equal to 5.5 cm or >0.5 cm expansion in 6 mos - IMMEDIATE Surgical repair
>4..5 vascular surgeon referral
can give B-blockers
What are the risk factors for aortic dissection?
- hypertension (most imp)
- age (50-60)
- Male
- vasculitis
- FH
- collagen disorders: Marfan’s Ehler’s Danlos
