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55 Cards in this Set
- Front
- Back
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What is Intermittent Claudication?
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Pain in lower extremities upon exertion relieved by sitting or resting
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When you have pain at rest w/ PAD, what is that indicative of?
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Critical Limb Ischemia
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4 main ways PAD pts present?
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Asymptomatic (50%)
Intermittent Claudication (most common symptomatic presentation) Critical Limb Ischemia Atypical Leg Pain |
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How many people over 70 have PAD?
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~20%
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Gender and PAD in people over 60?
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2-3% of men
1-2% of women |
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Patients you should consider PAD in?
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Anyone w/ exertional leg pain
Pts > 50yo w/ risk factors All pts > 70 yo ALL CARDIOLOGY Pts |
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How long do you usually have to rest to relieve intermittent claudication?
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3-5 minutes
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3 common sites of obstruction and their subsequent ischemia locations?
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Aorta/Iliac --> Butt, Hip. Thigh
Femoral and its branches --> Thigh and Calf Popliteal A --> Calf, Ankle, Foot |
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Typical Score for Intermittent Claudication on the SF-36 test as compared to normal adult?
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36 IC
50 normal adult |
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#1 modifiable risk factor for developing PAD/IC?
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SMOKING
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Protective Factor for developing PAD/IC?
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Alcohol
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How does Diabetes affect PAD development?
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It presents a decade earlier
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Dx of PAD in smokers?
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A decade earlier
3 times more common |
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Complications of Chronic Critical Limb Ischemia
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Ischemic Rest Pain
Arterial Ulcer Gangrene Non-Healing Lesion |
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Relationship between claudication and CLI?
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Claudication does NOT always preceed CLI
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Kickers for Ischemic Rest Pain?
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Must begin in distal foot or ischemic ulcer
Initially brought on by elevation and relieved by dependency Seriously painful |
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Key Points of Physical in PAD Pts?
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BP in both arms
Check Lipids Ulcers, Gangrene, Edema, atrophy AAA Bruits (carotid, subclav, abd, renal, fem) |
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Sx's of CAD/PAD?
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Arcus Senilis
Xanthelasmas Vertical Earlobe Crease Xanthomas Dependent Rubor Arterial Ulcer Gangrene |
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Types of Leg Ulcers?
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Venous
Arterial Neuropathic (not "diabetic") |
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Location of the different types of ulcers?
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Venous = perimaleolar
Arterial = on foot Neuropathic = Pressure Points |
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Pain and the different types of ulcers?
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Venous = little pain
Arterial = lots of pain Neuropathic = no pain |
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Typical Association w/ Venous Ulcers?
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Chronic Venous Insufficiency
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How does the CVI present?
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Lipodermatosclerosis
Hemosiderin |
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Granulation and bleeding in arterial ulcers?
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Little or none of either
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Typical association w/ Neuropathic Ulcers?
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Deep Infection
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Arterial Physical Exam for PAD?
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Listen for abdominal bruits
Palpate for AAA Palpate femoral, popliteal, post. tibial, and dorsalis pedis pulses Evaluate foot skin care |
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how do you grade pulses?
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0 = absent
1 = diminished 2 = normal |
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Is the DP pulse ever absent in pts w/o arterial disease?
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yes, but not often
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Which pulse is always abnormal if missing?
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PT
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What is Leriche Syndrome?
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Thigh and Butt Claudication
ED Atrophy of lower extremity muscles Aorto-Iliac occlusive disease |
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How can you usually diagnose PAD?
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H&P
at least for location and severity |
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Routine PAD Labs?
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Hgb/Hct
Glucose Complete Lipid Panel Plasma Homocysteine C-Reactive Protein |
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Key Noninvasive Vascular Test?
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Ankle-Brachial Index (ABI)
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Elements of the ABI?
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Right and Left Arm Pressures
Right and Left PT and DP Pressures ABI = Ankle Systolic Pressue/Brachial Systolic Pressure If pressures differ by side of body, use highest Must Be Reproducible |
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Normal and abnormal ABI values?
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Normal = .90-1.30
Mild = .70-.89 Moderate = .40-.69 Severe = <.40 |
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Which pts is ABI not as reliable for?
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Diabetics
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Differential Dx for PAD?
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Neurogenic Claudication
variable amounts of exercise not confined to one area slow to dissipate |
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General Rule for tissue loss?
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Must be arterial occlusions at two levels to cause tissue loss
unless end artery |
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5 year mortality for:
PAD w/ Claudication |
25%
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5 year mortality for:
PAD w/ claudication and amputation w/ no Rx? |
7%
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5 year mortality for:
PAD w/ CLI |
50%
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Rx for PAD?
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Risk Factor modification
Exercise Antiplatelet Rx Rx for Claudication Endovascular or Surgical Procedures |
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what type of exercise is most effective?
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SUPERVISED
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Drugs for Claudication?
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Pentoxifyline
Cilostazol |
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Which drug is better?
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Cilostazol
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Main contraindication of Cilostazol?
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CHF!!!!
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Indications for Revascularization?
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CLI
Intermittent Claudication (not really, only 7% need amputation in 5 years) |
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Main mode of arterial vascularization?
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Ateriogram
ultrasound cta mra |
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Indications for Revascularization are based on: ????
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Signs and Symptoms
NOT ABI or X-Ray findings |
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Goals of Limb Revascularization?
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Relieve Limb-Threatening Ischemia
Treat Claudication |
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When is revascularization indicated for intermittent claudication?
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Lifestyle-limiting
Continued disability despite non-surgical management Technically Feasible Favorable risk/benefit ratio |
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Most common Endovascular Modalities?
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Balloon Angioplasty
Angioplasty w/ Stents |
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Predictors of good outcome of Endovascular procedures?
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Short Lesion Length
Good Runoff Lack of Limb-threatening ischemia Paten Vessel rather than occlusion Lack of DM |
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Surgical Options for Aorto-Iliac Occlusive Disease?
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Endarterectomy
Aorto-Bifemoral Bypass (the standard) Femoro-femoral bypass Axillo-femoral bypass |
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Surgical Rx for Femoropopliteal Disease?
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Reversed GSV if Above Knee site
In Situ Vein if below knee site Polytetrafluoroethylene if no vein available ? |
