Peripheral Vascular Disease I and II Flashcards Preview

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Flashcards in Peripheral Vascular Disease I and II Deck (56)
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1

peripheral artery disease (PAD)

when blood flow to the extremities is blocked, usually due to atherosclerosis of the vessels

2

types of PAD

claudication

rest pain

tissue loss

3

claudication

muscle pain, called intermittent claudication

typically comes on with exercise and is relieved with rest

4

rest pain

as atherosclerosis progresses and blockage becomes more severe, pain may occur in the feet even when at rest

rest pain occurs because the arteries of the leg can no longer deliver adequate blood flwo to the feet, even at rest

generally worsens when the legs are elevated, such as wehn lying in bed at night

relieve may occur only when the feet are dangled

5

two drugs that are accepted treatment for claudication

cilostazol and pentoxifylline

cilostazol is much more effective

6

chronic changes in skeletal muscle histology

honeycomb pattern

increased adipose

increased inflammatory cells

increased angular fibers

decreased type III fibers

decreased gastroc strength - cross-sectional area

7

treatment for CAD

medication

exercise

risk factor modification and management

bypass surgery

endovascular interventions

8

emerging CAD therapies

gene therapy - VDGF165, VEGF121, hepatocyte growth factor (HGF), fibroblast growth factor 1 (FGF-1)

stem cell therapy - bone marrow, peripheral blood

9

acute mesenteric ischemia

caused by decreased intestinal blood flow that can be caused by a number of mechanisms

results in ischemia and subsequent reperfusion damage that may progress to the development of mucosal injury, tissue necrosis, and metabolic acidosis

10

intestinal blood supply

celiac axis

superior mesenteric artery

inferior mesenteric artery

11

types of acute mesenteric ischemia

embolic disease

thrombolic disease

nonocclusive mesenteric ischemia

venous thrombosis

12

embolic disease

embolus tends to lodge in SMA distal to middle colic artery

this preserves the proximal jejunum and transverse colon

doesn't go into the celiac because of the angle of the vessels

13

etiology of embolic disease

atrial tachyarrhythmia

MI

cardiomyopathy

heart defects

cardiac tumors

endocarditis

aortic mural thrombus

14

thrombotic disease

atherosclerosis

hypercoagulable state

15

etiology of nonocclusive mesenteric ischemia

caused by vasospasm

atherosclerosis is frequent

low flow states

hypovolemia

vasoconstrictors

vasoactive agents

aortic insufficiency

liver failure

cardiopulmonary bypass

16

venous thrombosis

superior mesenteric vein is the most common

sometimes the inferior mesenteric vein and portal vein

characterized by edema, hemorrhage, and sloughing

17

etiology of venous thrombosis

hypercoagulable state

malignancy

trauma

abdominal surgery

hepatic failure

pancreatitis

oral contraceptives

18

clinical presentation of embolic and thrombotic acute mesenteric ischemia

sudden pain out of proportion to exam

gut emptying

nausea

vomiting

diarrhea

19

clinical presentation of embolic and thrombotic chronic mesenteric ischemia

post prandial pain

weight loss

food fear

20

clincial presentation of NOMI and MVT

slower course

usually critically ill, hospitalized, intubated

abdominal pain

nausea and vomiting

bloody stool

dehydration

fluid shifts

21

diagnosis of MAD

laboratory studies

x-ray

ultrasound

CTA

MRA

contrast angiography is the gold standard

 

22

management of embolic MAD

early diagnosis

SMA embolectomy

anticoagulation

bowel resection

second look

23

management of thrombotic MAD

early diagnosis

SMA/CA bypass (venous)

anticoagulation

bowel resection

second look

24

management of NMI

correct underlying problem

systemic vasodilator infusion

catheter directed vasodilator infusion

25

management of venous thrombosis

resuscitation

anticoagulation

laparotomy if periotneal signs

? thrombolytic therapy

26

carotid artery disease plaque anatomy

commonly occurs at bifurcations

typically thickest at bulb and extends 2 cm

occurs along lateral wall of the carotid artery

27

pathophysiology of stroke

embolism of overlying thrombus

embolism of plaque fragment

low flow through post stenotic segment

28

clinical presentation of carotid stenosis

asymptomatic

transient ischemic attack (TIA)

stroke

29

diagnosis of carotid stenosis

carotid duplex - imaging, velicity measurements

MRA

CTA

contrast angiography

30

treatment of carotid artery disease

medical therapy - antiplatelet (aspirin and clopidogrel)

surgical therapy - carotid enarterectome (CEA) or carotid artery stenting (CAS)