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49 Cards in this Set
- Front
- Back
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Non-modifiable risk factors for PVD (4)
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-Age
-Gender: males -Race: AA -Family Hx |
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Modifiable risk factors for PVD (6)
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-Smoking
-HTN -High cholesterol -DM -Obesity -Stress |
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Etiology of chronic lower limb ischemia
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Occlusive process of tibial vessels with calcification of the arterial wall; primarily seen in pt's with DM
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Pathophysiology of chronic lower limb ischemia
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Atherosclerosis-->Claudication-->Rest PN-->Tissue loss from ulceration & gangrene
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Clinical presentation of chronic lower limb ischemia
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-Diminished or absent pulses
-Shiny, thin, hairless skin -Thickened & discolored nails -Delayed cap refill -PN or numbness of foot w/ walking -Ulceration/gangrene of foot/toes -Pallor when foot is elevated (Dependent rubor) |
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Management of chronic lower limb ischemia
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-Control risk factors
-Aerobic exercise -Cilostazol (vasodilator) |
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Etiology of acute arterial occlusion
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Occlusion from embolus or thrombus from: aortic aneurysm, A Fib, LV thrombus (post MI)
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6 P's of acute arterial occlusion
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-Pain (sudden onset)
-Pallor -Pulselessness -Paresthesia -Poikilothermia (coldness) -Paralysis (late) |
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Management of acute arterial occlusion
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-Heparin (to stabilize clot)
-IV fluids (dilute muscle brkdwn) -Thrombectomy/embolectomy -Revascularization |
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Etiology of mesenteric ischemia
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-Atherosclerosis + thrombosis
-Embolism from A Fib -Low flow state |
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Clinical presentation of mesenteric ischemia
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-AP after meals (severe, mid-gastric if acute)
-Epigastric bruit -Elderly Fe's +/- Vomiting -May progress to HOTN, tachycardia, & acute abdomen |
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Management of mesenteric ischemia
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-Revascularize with endartectomy/bypass/angioplasty
-IV Fluids -Gastric decompression -Bowel resection |
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Etiology of renal A stenosis
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-Atherosclerosis
-Fibromuscular dysplasia -Scleroderma |
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Clinical presentation of renal A stenosis
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-Acute onset of severe HTN in pt's <35 or >55
-Acute worsening of previously well controlled BP -Uncontrolled BP, despite multiple meds (esp. DM) +/- Abdominal bruits -Renal insufficiency w/ no other cause |
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Management of renal A stenosis
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-If >60% stenosis w/ uncontrolled BP or chronic renal insufficiency:
-Stent -Bypass |
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Etiology of AAA
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-Atherosclerosis
-Inherited C tissue disorder (Marfans) -Acquired C tissue disorder (inflammatory) -Fungal infection |
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Pathophysiology of AAA
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-Focal dilation of A
-Bigger = higher risk of rupture -All major A's can be affected -Progression: Aneurysm-->Rupture-->Thromboembolism-->Compromised renal bf |
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Clinical presentation of Non-ruptured AAA
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-Asymptomatic (most)
-Pulsatile mass on abd exam -Incidental finding of CT -Lower extremity embolic phenomena -FH |
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Clinical presentation of Ruptured AAA
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-Acute back PN
-Pulsatile, tender abd -Shock -80% mortality |
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Management of AAA
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-Trad Sx resection w/ graft
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Etiology of aortic dissection
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-NOT atherosclerosis
-Marfan's -HTN -Pregnancy -Age |
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Pathophysiology of aortic dissection
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-Tear in intima-->bf between intima & adventitia-->tear progresses-->false lumen 'occludes' true lumen
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Clinical presentation of aortic dissection
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-Severe intrascapular PN +/- anterior CP
-HTN -Deficits in blocked organ systems -Absent/diminished/unequal peripheral pulses |
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Management of aortic dissection
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-Type A-Repair via replacement (EVAR)
-Type B-BP control & repair if end organ ischemia |
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Doppler ultrasound for evaluation of PVD
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-High velocity & turbulence seen w/ stenosis
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MRA for evaluation of PVD
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-Contrast dye will be be vacant in stenotic areas
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CTA for evaluation of PVD
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-3D images showing areas of stenosis or occlusion, & areas of angioneogenesis
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Angiography for evaluation of PVD
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-Invasive study that is nephrotoxic
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Etiology of Varicose veins
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-Valvular incompetency
-Muscle dysfunction -Obstruction |
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Clinical presentation of Varicose veins
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-Telangecasias
-Edema -Aching PN, stinging, or heaviness |
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Diagnostic evaluation for Varicose veins
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-Venous ultrasound
-MRI/MRV -Venogram -+/-ABI |
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Management of Varicose veins
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-Support hose
-Weight loss -Leg exercises -Elevation -Sclerotherapy, ligation, stripping, radiofrequency ablation |
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Complications of Varicose veins
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-Thrombophlebitis
-Bleeding w/ minor trauma in elderly |
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Pathophysiology of CVI
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-Valve leaflets don't close b/c they are thickened & scarred
or -Vein dilation |
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Clinical presentation of CVI
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-Progressive edema of the leg
-Color changes in skin -Itching -Ulcers at/above ankle |
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Management of CVI
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-Compression stockings
-Avoid long periods of sitting or standing -Leg elevation |
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Post-phlebitic syndrome
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-Venous clot that doesn't resolve
or -Scarring of venous valves following thrombophlebitis |
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Thrombophlebitis
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-Acute blood clot within a vein
1.Superficial 2.Deep |
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Clinical presentation of Superficial thrombophlebitis
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-Tender, palpable cord
-Erythema -Induration (hardening) -@ recent IV site |
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Management of Superficial thrombophlebitis
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-Usually resolves within 1-2 wks
-Venous ultrasound to r/o DVT -Elevation -Warm compresses -NSAIDs for PN relief |
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Primary Lymphedema
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-Obstruction of the proximal or distal lymphatics due to congenital abnormalities
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Secondary Lymphedema
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-Inflammatory or mechanical lymphatic obstruction from trauma, regional LN resection or irradiation, or LN malignancy
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Clinical presentation of Lymphedema
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-Painless persistent edema of one or both lower extremities, primarily in young women
-Pitting edema w/out ulceration, varicosities, or stasis pigmentation |
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Management of Lymphedema
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-Elevation
-Compression stockings |
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Popliteal Aneurysm
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Caused by an obstruction of blood flow or embolic event
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Clinical presentation of a Polliteal Aneurysm
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Upon palpation of the popliteal fossa:
-presence of a +3 or higher pulse or hard mass. |
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Etiology of Popliteal Aneurysm
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-Atherosclerosis
-Inherited connective tissue disorder (Marfan's) -Acquired connective tissue disorder (Inflammatory) -Fungal infection |
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Clinical presentation of Intracranial Aneurysm
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-Sudden loss of consciousness (50%)
-Excruciating HA -Rise in ICP -Blood in CSF via CT |
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Management of Intracranial Aneurysm
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-Ligation
-Coiling -Clipping in ruptured aneurysm |
