Term
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Definition
| peripheral arterial disease, a concept of developing progressive atherosclerosis in the distal arterial system which feeds the lower extremities |
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Term
| what what percent occulsion of arteries do you start seeing flow limitation distally? can this progress to total occulsion at a segmental level? |
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Definition
| 75%, it is possible to have total occulsion of a vessel at a segmental level |
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Term
| what is intermittent claudication? where does it often occur? can it progress? |
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Definition
| ischemically derived cramping pain in the legs during often experienced during walking, which often occurs in the calves. it can progress to where the occlusion becomes tighters and/or multi-segmental |
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Term
| what does the distal abdominal aorta bifurcate into? |
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Definition
| the common illiac -> external and internal illiac. the internal feeds the genitals and buttocks, and the external becomes the femoral which goes down to the knee (superficial femoral artery: site of caths) where it trifurcates in the popliteal fossa giving off the ant tibial -> the dorsalis pedis (dorsum), the post tibial -> goes down the medial malleolar gutter, and the peroneal which goes into the lateral malleolar gutter |
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Term
| **where is the most common area of occulusion in non-diabetic pts' lower extremity? |
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Definition
| the superficial femoral artery |
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Term
| **where is the most common area of atherosclerotic narrowing in a diabetic pts? |
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Definition
| the popliteal artery in the popliteal fossa (diabetics favor smaller vessel disease) |
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Term
| in diabetics and non-diabetics where is claudication if either the sup femoral artery or popliteal artery are occuluded? |
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Definition
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Term
| in diabetics whose occulusion happens in the anterior and posterior tibial arteries (even smaller), where does their claudication occur? |
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Definition
| in the foot and arch muscles |
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Term
| what happens if proximal occulusion in the internal illiac? |
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Definition
| claudication can develop in the ipsilateral buttock and upper thigh. males can also get mild ED - *leriche’s syndrome* |
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Term
| what is proximal occulusion in the internal illiac commonly misdiagnosed as? |
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Definition
| DJV of hip, L1, L2 spinal root neuropathy |
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Term
| how is occlusion of the internal illiac treated? |
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Definition
| angiogram, balloon and stint or bypass |
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Term
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Definition
| ankle brachial index, which is a ratio of ankle systolic pressure/brachial systolic pressure that quantitates arterial insufficiency of lower extremities using a doppler and BP cuff |
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Term
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Definition
| greater than 1, b/c radii of ankle arteries are smaller than radii of brachial artery, and thus should have higher pressure |
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Term
| what happens to leg pressure as progressive atherosclerotic flow-limiting lesions develop (often in SFA, popliteal arteries or in series)? |
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Definition
| pressures in ankle arteries drop, and ABI drops below normal |
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Term
| what ABI is diagnostic for PAD? is this symptomatic in terms of pain? are pts at a higher risk w/this? do pts with this likely have occusions? |
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Definition
| <.9, at which pts may not experience any other symptoms, such as pain - but cardiac mortality at this point is 6-8x more than other people in your same demographic. pts with .9 and lower ABI have a 95% chance of having a 50% cross sectional occulsion somewhere in their leg |
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Term
| is a 50% arterial occlusion flow limiting? |
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Definition
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Term
| if someone has a .9 or less ABI, this puts them at a high risk for cardiac disease. what does this mean in terms of how other risk factors need to be regulated? |
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Definition
| their cholesterol needs to be <190, LDL needs to be <70 (w/aggressive diet and medical therapy, plaque may be reabsorbed) |
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Term
| why does smoking need to be stopped if a pt has an ABI <.9? |
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Definition
| smoking increases systemic vascular resistance in collateral flow, and in areas such as the geniculate around the knee, this can be a major problem |
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Term
| what other risk factors besides smoking need to be addressed in pts with an ABI <.9? |
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Definition
| cholesterol, HTN (<130/80 if diabetic, <140/90 if non-diabetic), fat, and sugar if diabetic |
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Term
| what is the common treatment for PAD? |
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Definition
| stop smoking, exercise daily, modify cholesterol, control diabetes, lower blood pressure, and lose weight |
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Term
| what are the medications commonly prescribed for PAD? |
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Definition
| methylxanthine inhibitors, trental, pletal, and an anti-platelet cocktail |
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Term
| what do methylxanthine inhibitors do? |
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Definition
| this is a phosphodiesterase inhibitor that elevates cAMP in cells (vascular and endothelia), which leads to a vasodilatory state - anti-thrombotic conditions (opens up collaterals) |
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Term
| what is a warning for pletal? can it help with walkability? |
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Definition
| pts cant take this if they have ever had CHF (excludes a lot of geriatric pts - they should take trental). taken 3x/day, pletal can improve walkability |
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Term
| what is the antiplatelet cocktail commonly prescribed for PAD? |
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Definition
| asa and plavix daily, which inhibit platelets at different sites - reduces cardiac mortality by 30-50%, and increases walkability with trental/pletal |
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Term
| what is characteristic of pts with .9-.8 ABI? (mild PAD) |
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Definition
| they are generally asymptomatic, though the distal arteries in the foot may be mildly dampended in intensity |
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Term
| what is characteristic of pts with .79-.65 ABI? (moderate PAD) |
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Definition
| symptoms start, and pts claudicates at about 2 city blocks (1000 ft) |
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Term
| what is characteristic of pts with .64-.5 ABI? (severe PAD) |
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Definition
| these pts can claudicate at a city block or half |
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Term
| what is characteristic of pts with <.5 ABI? |
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Definition
| this is considered resting ischemia, and between .4-.25, pts are home-bound, at less than .25, pts can develop rubor pallor syndrome |
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Term
| what is rubor pallor syndrome? |
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Definition
| when ABI is <.25, gravity is the only thing pulling RBCs to the foot. if gravity is taken away (feet are raised), the foot goes white and is very painful, when they stand up it turns bright red w/the return of blood. pt w/this are one step away from amputation b/c resultant gangrene, cellulitis, and osteomyelitis are unresponsive to antibx that cannot reach the area due to ischemia |
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Term
| why is claudication not often mentioned in checkups? |
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Definition
| b/c it is considered "part of getting older" and it comes on very slowly |
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Term
| what is a quick screen for arterial health? |
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Definition
| a handheld doppler on any artery should give a triphasic sound, but w/ABI's <.8, you may have mono or biphasic sound characteristic of flow-limiting proximal PAD (ischemia is most potent vasodilator known) |
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Term
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Definition
| in both arms, find the artery, pump up a blood pressure cuff until silent, slowly let it out - and when you hear the first sound through the doppler, its the systolic pressure. do the same thing in the dorsalis pedis (if hear one or two sounds you already know you have <0.80), and listen for the first sound (systolic) - then do the same for the post tibial and peroneal in each foot. |
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Term
| how is the ABI calculated? |
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Definition
| take the highest ankle systolic and divide it by the highest arm systolic |
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Term
| how does the ABI characterize PAD? |
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Definition
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