Flashcards in Peripheral Vascular Disorders Deck (44)
What are the SxS associated with Peripheral Arterial Disease (PAD)?
1) Structural - Hair loss distal to occlusion, thick and op ague nails, shiny and dry skin and muscle atrophy.
2) Color Changes - Elevational pallor and dependent rubor.
3) Pulse - diminished or absent pulses distal to occlusion, cool extremities.
4) Sensation Changes - Paresthesia, numbness and tingling.
6) Edema - Although usually absent, may be present and related to dependency.
What are the 5 common Risk Factors for PAD?
1) Family Hx
2) Age > 70 yrs old
5) Preexisting Health Conditions - CAD, diabetes, HTN, dyslipidemia, clotting disorders, hyperhomcysteinemia.
What is Homocysteine? How is it related to PAD? How is it treated?
1) Homocysteine is a protein that promotes coagulation
2) Elevated Homocysteine levels are associated with genetic factors and a diet low in folic acid, Vit B6 and Vit B12.
3) Tx includes Vit B6 and Vit B12, which often lowers Homocysteine levels.
What is the hallmark symptom for PAD in the lower extremity?
Intermittent Claudication - Pain that occurs with activity and is relieved with rest. Caused by inability of the ARTERIAL system to provide blood flow with increased demand.
Rubor a reddish-blue coloring of the skin that occurs when the extremity is placed in a dependent position after it has been elevated. This color change suggests severe PAD, in which vessels cannot constrict and remain dilated.
What are the Pharmacological treatment used in patients with Intermittent Claudication?
1) Cilostazol - A phosphodiesterase III inhibitor that is a vasodilator and also interferes with platelet aggregation.
2) Aspirin and Clopidogrel are anti platelet drugs indicated for the prevention of cardiovascular ischemic events in patients with IC but not for treatment of it.
What is the main difference between grafts used to bypass occluded vessels below the knee and those above the knees?
Grafts below the knee require a native vessel (i.e., autologous, the patients own vein) to ensure patency; however, synthetic grafts may be used for bypass procedures on larger vessels above the knee.
What is the reasoning behind teaching patients with PAD to avoid temperature extremities?
Excess heat may increase the metabolic rate of the extremities and increase the need for oxygen beyond that provided by the reduced arterial flow through the diseased artery.
Cold temperature causes vasoconstriction, which decreases perfusion to the extremities.
Why is the patient with PAD taught to avoid stress and also crossing their legs?
1) Emotional upsets cause vasoconstriction by stimulating the SNS.
2) Crossing of the legs is avoided to prevent vessel compression.
Describe Subclavian Steal Syndrome
Subclavian Steal Syndrome occurs when there is diminished flow to the arm from the subclavian artery due to stenosis, there will be a preferential reverse flow down the vertebral artery to the arm when the arm is being used.
What are the 3 Inflammatory Disorders, mentioned in Pellico, that cause cause ⬇ peripheral arterial circulation?
1) Takayasu's Arteritis
2) Bechet's Disease
3) Giant Cell Arteritis
Describe Raynaud's Disease Vs Raynaud's Phenomenon.
Raynaud's Disease refers to vasospasm that occurs with cold or stress.
Patients with Scleroderma or SLE may have the same Sxs. This is called Raynaud's Phenomemon
What are the SxS of Raynauds Disease in the order that they occur?
The patients skin becomes cyanotic due to vasospasm, then vasodilation causes rubor, then numbness tingling and burning pain occur.
What are the Tx available for patients with Raynaud's Disease?
1) Avoid stimuli i.e., cold or tobacco.
2) CCBs may be given to relieve some symptoms
3) Sympathectomy - Interrupting the sympathetic nerves
What is Buerger's Disease (aka Thromboangiitis Obliterans)? What are the SxS and how is it treated?
1) Buerger's Disease is an autoimmune disease characterized by recurring inflammation of the intermediate and small arteries and vein, resulting in thrombus formation and vessel occlusion. It is usually caused by smoking.
2) SxS include pain that is bilateral and symmetric with focal lesions.
3) Tx includes sympathetic block to dilate vessel and increase blood flow. Smoking cessation as well.
What is an Aneurysm? What are the 2 different types?
An Aneurysm is a localized out-pouching, sac or dilation formed at a weak point in the artery wall.
1) Saccular Aneurysm - Projects from one side of the vessel only.
2) Fusiform Aneurysm - Occurs when the entire arterial segment becomes dilated.
What is a Mycotic Aneurysm?
Small aneurysms due to localized infections.
What are the 5 Risk Factors for Aneurysms?
1) 50 yrs and older
3) Tobacco use
4) Family Hx
What are the 2 most important diagnostic indications of an AAA and how is an AAA diagnosed?
1) A pulsatile mass in the abdomen and a systolic bruit heard over the mass.
2) Duplex ultrasonography or CT is used to determine the size, length, and location of the aneurysm.
Which class of meds are used to treat a stable AAA?
Antihypertensives - i.e., ACEIs, ARBs, CCBs, BBs, and diuretics.
What are the SxS of a Thoracic Aortic Aneurysm?
1) Pain - usually constant but may occur when PT is supine
2) Brassy cough, hoarseness, Stridor, or aphonia (loss of voice)
3) Dysphagia (difficulty swallowing) from pressure of aneurysm pressing on esophagus.
4) Dyspnea (from pressure of aneurysm pressing on airways)
5) Unequal Pupils from pressure against the cervical sympathetic chain.
How is a Thoracic Aortic Aneurysm usually Diagnosed?
TEE or CT
What is an Endoleak?
An Endoleak is a complication of endovascular graft surgery. It is a persistent leaking of blood out of the graft and into the aneurysm sac.
What is a Dissecting Aneurysm?
A Dissecting Aneurysm occurs when a tear develops in the intima or the media of the aorta, resulting in a dissection.
What are the 3 main causes of a Dissecting Aneurysm?
2) Blunt force chest trauma
3) Cocaine use
(T/F) The patient who has had endovascular repair must lay supine and be on bed rest post operatively.
Upper extremity venous thrombosis is not as common as LEVT, what are the causes of UEVT?
1) IV catheters
2) Hypercoagulation disorders
3) Effort Thrombosis - caused by repetitive motions, usually from playing sports.
What is Virchow's Triad?
Virchow's Triad are the 3 components that are thought to contribute to venous thrombosis:
1) Stasis of Blood
2) Vessel Wall Injury
3) Altered Coagulation
(T/F) Venous Thrombosis is associated the affected limb being warmer than the unaffected limb and the affected limb having edema.