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Flashcards in PVD Deck (48):
1

the presence of an carotid bruit has what effect on cardiovascular outcomes?

  • increased risk for MI and cardiovascular death 

2

management of asymptomatic carotid stenosis 

  1. treatment HTN
  2. treat hyperlipidemia
  3. treat DM
  4. stop smoking
  5. aspirin 

3

carotid bruits are relatively common, occuring in approximately 4% of what population?

adults >45 y.o 

4

does having a carotid bruit mean you have severe carotid stenosis?

  • No, sensitivity of a carotid bruit for the detection of severe carotid stenosis is poor
  • **however, specificity is more than 90% 

5

symptomatic carotid stenosis 50-99% should be referred for what intervention techniques

  1. carotid endarterectomy
  2. carotid artery stenting 

6

asymptomatic carotid stenosis 60-99% should be referred for what intervention techniques

  • carotid endarterectomy
  • carotid artery stenting not recommended

7

95% of atherosclerotic aneurysms affect which part of the aorta 

abdominal aorta 

8

what percentage of atherosclerotic aneurysms have symptoms prior to rupture 

14% therefore high mortality 

9

symptoms of ascending aortic aneurysm 

  • compression-swelling head/arms
  • pain: chest, neck, back
  • hoarseness
  • valve regurgitation 

10

symptoms of arch and descending aortic aneurysm 

  • wheezing, cough, SOB
  • hemoptysis
  • Hoarseness (RLN)
  • dysphagia
  • chest or back pain 

11

management of thoracic aortic aneurysms

  1. beta blockers: decrease force of ejection
  2. angiotensin II receptor blockers

12

thoracic aortic aneurysms wider than what is an absolute indication for surgical/endovascular indications 

5-6cm

13

Type A thoracic aortic dissection 

Ascending aorta 

  • 75% of cases 

14

Type B thoracic aortic dissection 

Descending aorta 

15

aortic dissection: potential signs and symptoms 

  • chest pain
  • back pain (particularly between shoulder blades)
  • HTN in 2/3 patients 

16

Aortic dissections usually occur where

thoracic aorta 

17

initial medical management of aortic dissection 

  • Beta blockers -> decrease force of ejection 
  • then vasodilators like Nipride -> reduce systolic BP

18

how is abdominal aortic aneurysms diagnosed 

ultrasound

19

management of abdominal aortic aneurysms less than 5/5 cm, not enlarging rapidly, asymptomatic 

ultrasound follow-up every 6-12 months 

20

what are the indications for intervention of abdominal aortic aneurysms

  • > 5.5 cm
  • symptomatic
  • rapid expansion: > 0.5 cm in 6-12 months 

21

ruptured AAA associated with what symptoms 

  • abdominal pain
  • pulsatile abd mass
  • tenderness
  • hypotension 

22

AAA treatment 

  • resection and tube graft placement
  • endovascular stent graft, often bifurcated: preferred 

23

treatment of chronic  aorto-iliac occlusive disease 

  • aortic bypass surgery
  • endovascular: angioplasty +/- stenting 

24

presentation of acute  aorto-iliac occlusive disease 

absent femoral pulses 

25

treatment of acute  aorto-iliac occlusive disease

***emergency

  1. quick imaging
  2. operate 

26

characteristics of what condition?

  • asymptomatic
  • "intermittent claudication"
  • critical leg ischemia-limb threat 

peripheral arterial disease 

27

what is the most common form of PVD? what is it caused by?

  • peripheral arterial disease 
  • atherosclerosis 

28

Name the symptoms of peripheral vascular disease 

  1. claudication
  2. rest pain
    1. toes and dorsum of foot
  3. Leriche syndrome

29

what is Leriche syndrome present with 

**aortoiliac disease

  • decreased femoral pulses
  • impotence
  • buttocks and thigh claudication 
  • numbness and cold feeling develop as disease progresses 

30

clinical presentation

  • hair loss on leg/foot
  • atrophic skin; nail changes 
  • ulcers

chronic arterial insufficiency 

31

ankle brachial index. What is it and what it is used for? what is a normal value?

  • ABI = ankle systolic pressure / brachial systolic pressure 
    • normally > or = to 1.0
  • 95% sensitivity for chronic arterial insufficiency 

32

most common sites affected with chronic arterial insufficiency 

  • superficial femoral
  • popliteal 

33

what is the main symptom of chronic arterial insufficiency 

  • claudication
    • ischemic pain (crampy, tightening sensation) in the lower legs when walking
    • pain resolves within minutes of stopping to rest
    • most common in calves, less frequent in buttocks and thighs  

34

claudication is usually associated with activity. Define the distance able to walk 

  • > 2 blocks = mild
  •  one block = moderate
  • < 1 block = severe 

35

why do 65-70% of claudication symptoms remain stable or improve with time 

development of collateral vessels 

36

if you have claudication, what other conditions would make the prognosis worse 

  • diabetes
  • smoking 

37

List Ankle Brachial index assesment of disease severity 

  • > or = 1: normal
  • 0.70-0.99: mild
  • 0.50-0.69: moderate
  • < 0.50: severe 

38

Name the various AB index that are associating with the following symptoms: no claudication, claudication, rest pain, limb threat 

  • no claudication: > 0.8
  • claudication: 0.5-0.8
  • rest pain: 0.2-0.49
  • limb threat: < 0.2

39

in diabetic patients with calcified vessels, the ABI may change how?

be falsely high 

  • if > 1.1 think non-compressible vessels 

40

first therapy for claudication 

stop-start walking regimen 

  • regular daily walks 30-45 min/day
    • at least 3 x/week for at least 6 months 

41

therapy for claudication class I 

  1. smoking cessation
  2. lipid-lowering therapy
  3. aspirin

42

what bypass graft is most common for femoral-popliteal revascularization 

Goretex graft

43

presentation

  • leg pain worsens with standing
  • leg swelling
  • varicosities
  • worsens as day progresses 

venous insufficiency 

44

what are the 5 P's of acute obstruction 

  • Pain
  • Pallor
  • Paresthesia
  • Paralysis
  • Pulselessness 

45

 compartment syndrome. List the 6 presenting P's 

commonly seen after reperfusion of ischemic limb, typically calf 

  • Pain out of proportion to finding
  • Passive stretch pain
  • Paresthesias
  • Pokliothermia: abn temp regulation
  • Paralysis
  • Pulselessness

46

treatment of  compartment syndrome

fasciotomy 

47

surgical treatment of varicose veins 

 

  • sclerotherapy
  • laser therapy 
  • vein stripping 

48

first line management of varicose veins

  1. limb elevation 30 min 3-4 x/day to decrease edema 
  2. compression therapy