whos at risk for LE PAD
- Under 50 w/ diabetes + one other risk factor ( smoking, dyslipidemia, hypertension, or hyperhomocysteinemia)
- 50 - 69 and hx of smoking or diabetes
- 70+ yo
- Known atherosclerotic coronary, carotid, or renal artery disease
non-coronary arterial narrowing causing a mismatch btwn organ supply & demand causing intermittent sx of claudication &/or tissue ischemia
PAD definition
sx of intermittent limb claudication, non-nocturnal cramps & atypical fx of fatigue, heaviness, dysesthesia/cold sensation
LE PAD
2 surgery options for LE PAD
bypass
vein or synthetic graft used
3 tx of LE PAD
surgery
tx underlying cause
angioplasty/stent
4 situations when you do angioplasty/stent for LE PAD
- persistent limiting claudication
- prevents working or ADL
- rest pain
- tissue loss/non healing ulcers
2 major tx goals w/ treating PAD
- limb outcome– improved walking, prevent CLI & amputation
- better CV outcome– less non fatal event morbidity and less fatal mortality
Repetitive episodes of biphasic color change (at least 2 of pallor, cyanosis, erythema) in either cold or normal environment
raynaud’s phenomenon
pathophys of raynaud’s
out of control vasoconstriction/vasospasm in endothelin cells of capillaries; not well understood yet
how are pulses affected in raynauds vs buergers
- raynauds– pulses present
- buergers– pulse decreased or absent
is necrosis common in raynauds vs buergers
- w/ raynauds, if present it suggests secondary cause
- w/ buergers, its more common
primarily affects fingers, can affect toes, thumbs, nipples, nose, earlobes
raynauds
3 phases of raynauds
- initial ischaemia– pallor
- cyanotic phase
- hyperaemic phase– red/purple
3 tx of raynauds
- find & tx underlying cause– maintain core temp, avoid cold, stop vasconstrictive Rx, gloves
- promote vasodilation
- prevent vasoconstriction
Rare combo of acute inflammation and thrombosis of arteries and veins; obstructs blood flow to tissues– pain, can cause ulcers & gangrene; Upper & lower extremities affected
buergers dz
sx of pain or tenderness, numbness/tingling in hands/feet, ulcers or gangrene, discoloration, 2+ limbs affected, pain may increase w/ activity & decrease w/ rest
buergers
cause of buergers
Thought to be autoimmune rxn triggered by tobacco
dx of burgers & raynaud
start eval early
doppler US
angiogram of UE/LE
how is buergers tx
prevention is treatment
* no tobacco
* gentle massage for circulation
* move around more; no barefoot
* report injuries early
what cm is the risk of AAA dissection 25%/year
over 6 cm
2 situations where AAA screening should be considered
AAA fam hx < 65
smoking hx
3 imaging options to dx AAA
US
MRA
CT scan
2 tx options for AAA
underlying cause
angioplasty/stent
when can you do surgery on AAA
5-6cm (benefits outweigh the risk)
