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16 Cards in this Set
- Front
- Back
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Scope of peripheral vascular disease
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What is Peripheral Vascular Disease?
- “Disorders of arteries, veins and lymph vessels outside of the heart and brain.” What are common peripheral artery problems? - “Occlusions of carotid arteries (stroke risk) and leg arteries, and aneurysms of the aorta.” What are some common peripheral vein problems? - “Varicose veins, deep vein thrombosis (DVT), lower extremity venous insufficiency and ulcers.” |
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Mechanisms underlying peripheral artery occlusions
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Stenosis (narrowing of the artery lumen)
-Most commonly from atherosclerosis -Others --Arteritis --Dissection --Trauma Thrombosis -Most commonly from an underlying plaque or stenosis -Others --Dissection --Thrombosed aneurysm Embolism (occlusion of the artery lumen by material dislodged from a more proximal intravascular site) -Most commonly a thrombus from the heart -Others --Heart valve vegetation --Heart tumor (e.g. atrial myxoma) --More proximal artery (thrombus or atherosclerotic plaque material) |
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Acute vs chronic peripheral artery occlusion
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Acute occlusion (e.g. embolism or plaque rupture)
-Sudden severe symptoms of end-organ ischemia -No time to develop compensatory collateral blood flow Chronic occlusion (e.g. atherosclerotic stenosis) -Slowly progressive symptoms, often less severe -Time for small bridging collateral arteries to develop, bringing flow around the site of stenosis/occlusion |
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Common “Chief Complaints” or reasons for referral to a vascular specialist
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Leg pain (at rest or with ambulation)
Toe ulcers or gangrene Leg swelling Recent stroke (CVA) or transient ischemic attack (TIA) Bruit in the neck Pulsatile abdominal mass Abdominal aortic aneurysm (AAA) found incidentally on imaging done for another reason |
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Associated risk factors and conditions for peripheral vascular disease
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Atherosclerosis and its risk factors
-Heart disease, stroke, smoking, diabetes, lipids, etc. Altered exercise capacity -Dyspnea -Exertional Angina -Leg pain with ambulation (claudication) Clotting disorders or “thrombophillia” Family history of vascular problems |
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Hallmarks of acute limb ischemia
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Six "P's"
Pulselessness Pain Pallor Poikilothermia (cold) Paresthesias Paresis/Paralysis |
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Examination of peripheral pulses
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Palpation
-Grading pulse strength -Vessel caliber (aneurysms) -Thrill (indicative of stenosis or fistula flow) Auscultation -For bruits indicative of stenosis Doppler assessment of pulses -Triphasic (normal) -Biphasic or Monophasic (blunted, lacking flow reversal) Severe stenoses create a pressure drop, turbulence, and loss of energy that can be felt as a vibration (thrill) or ascultated similar to a heart murmur (bruit) |
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Grading of pulses
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Traditional:
4+ Normal 3+ Slightly reduced 2+ Markedly reduced 1+ Barely palpable 0 Absent Basic 2+ Normal 1+ Diminished 0 Absent |
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Skin changes associated with arterial pathology
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Decreased temp
Pallor, mottling Hair loss Ulceration Gangrene |
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Skin changes associated with venous pathology
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Edema
Varicosities Dermatitis (lipodermatosclerosis) Thickened skin Bronze discoloration Ulceration Gaiter distribution |
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Ankle-Brachial Index (ABI)
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Opening pressures measured by Doppler, supine, at rest.
-In both ankle and arm Highest of DP or PT in each leg divided by highest brachial artery pressure >1.0 Normal or possibly non-compressible from heavy calcification (e.g. diabetes) <0.9 Abnormal, likely claudication (mean 0.6), marker of increased risk for heart disease <0.6 Rest pain (mean 0.3) <0.3 Non-healing ulcers or gangrene (mean 0.1) |
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Duplex ultrasonography
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Combines B-mode ultrasound & color doppler with spectral analysis
Increased velocities and spectral broadening correlate with degree of stenosis Gold standard in screening for carotid occlusive disease Also used in renal, mesenteric and extremity arteries and bypass grafts to define stenoses. Gold standard in screening for Deep Venous Thrombosis -Noncompressible enlarged vein , abnormal flow, visible thrombus |
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Pulse volume recordings and segmental pressures
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Measures pulse waves
Commonly used to localize arterial occlusive problem |
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Digital Subtraction Angiography (DSA)
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Gold Standard
-Artery occlusive disease -Detailed lumen structure (but doesn't show artery wall) Invasive -Requires artery puncture -Risk of bleeding Potential for treatment at same time -Angioplasty -Stent Contraindications -Iodinated contrast may cause renal insufficiency -Allergy -Drug reactions: Metformin |
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CT Angiography (CTA)
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Non-Invasive (radiation)
Contraindications -Iodinated contrast --renal insufficiency --allergic reactions --drug reactions: metformin Images -Artery wall --Calcium --Thrombus -Lumen -Adjacent structures 2D and 3D reformatting |
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MR Angiography (ceMRA)
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Non Invasive
Contraindications -Gadolinium contrast --renal insufficiency --Dermatofibrosis -Metal --Pacemakers --Recent stents -Claustophobia Images -Lower resolution than CTA -Artery wall -Lumen -Adjacent structures 2D and 3D reformatting |
