STEP2: CARDS PAD Flashcards
(8 cards)
what are the different kinds of claudication?
Vascular Claudication (Intermittent Claudication)
Neurogenic Claudication (Pseudoclaudication)
What is the primary underlying cause of Vascular Claudication and how is its pain typically relieved?
Vascular Claudication: Cause: Peripheral Artery Disease (PAD) (insufficient blood flow due to arterial narrowing). Relief: Characteristically relieved by standing still and resting (does not require changing body position).
How does Neurogenic Claudication differ from Vascular Claudication in terms of cause and relief?
Neurogenic Claudication: Cause: Lumbar Spinal Stenosis (nerve compression in the spine). Relief: Characteristically relieved by changing body position, specifically flexing at the waist (e.g., sitting, leaning forward like a ‘shopping cart sign’).
What are key associated signs to differentiate Vascular Claudication from Neurogenic Claudication?
Vascular Claudication: Peripheral pulses: Diminished or absent. Trophic changes: Shiny, hairless skin, cool limbs, non-healing ulcers. ABI: Often low (<0.9).
What are the associated signs of Neurogenic Claudication?
Neurogenic Claudication: Peripheral pulses: Typically normal. Trophic changes: Absent. Neurologic exam: May show focal deficits (motor/sensory) after provocation, otherwise normal.
ABI
Normal ABI (0.91 - 1.30): Suggests no significant narrowing or blockage of the leg arteries.
Severe PAD (<0.40): Suggests severe arterial disease, often associated with rest pain, non-healing ulcers, or gangrene (critical limb ischemia).
Non-compressible/Calcified Arteries (>1.30 or >1.40): A high ABI indicates that the arteries are stiff and calcified, making them difficult to compress with a blood pressure cuff. This is often seen in patients with long-standing diabetes or advanced kidney disease. In these cases, the ABI may be falsely elevated and unreliable for diagnosing PAD. Further tests like a Toe-Brachial Index (TBI) or arterial duplex ultrasound may be needed.
What is the approach to treatment for PAD?
Cilostazol is a phosphodiesterase III inhibitor that has vasodilatory, antiplatelet, and antithrombotic properties. This drug may be considered as a therapeutic trial for 3–6 months in patients with PAD and claudication who remain symptomatic despite conservative measures (e.g., smoking cessation, supervised exercise therapy). Cilostazol improves symptoms of claudication and walking distance but has not been shown to decrease major cardiovascular events. Adverse effects are common and include headache, palpitations, diarrhea, and dizziness.
In addition to cilostazol, all patients with PAD should receive medical therapy with an antiplatelet agent (aspirin or clopidogrel), a statin to reduce the risk of myocardial infarction, stroke, and mortality, and antidiabetic agents if appropriate.
Bypass surgery is a treatment option for patients with PAD and chronic l
When do we consider bypass surgery in PAD?
chronic limb threatening ischemia; rest pain, ulcers, gangrene
