PVD

Question 1

the presence of an carotid bruit has what effect on cardiovascular outcomes?

Answer 1

• increased risk for MI and cardiovascular death

Question 2

management of asymptomatic carotid stenosis

Answer 2

1. treatment HTN
2. treat hyperlipidemia
3. treat DM
4. stop smoking
5. aspirin

Question 3

carotid bruits are relatively common, occuring in approximately 4% of what population?

Answer 3

adults >45 y.o

Question 4

does having a carotid bruit mean you have severe carotid stenosis?

Answer 4

• No, sensitivity of a carotid bruit for the detection of severe carotid stenosis is poor
• **however, specificity is more than 90%

Question 5

symptomatic carotid stenosis 50-99% should be referred for what intervention techniques

Answer 5

1. carotid endarterectomy
2. carotid artery stenting

Question 6

asymptomatic carotid stenosis 60-99% should be referred for what intervention techniques

Answer 6

• carotid endarterectomy
• carotid artery stenting not recommended

Question 7

95% of atherosclerotic aneurysms affect which part of the aorta

Answer 7

abdominal aorta

Question 8

what percentage of atherosclerotic aneurysms have symptoms prior to rupture

Answer 8

14% therefore high mortality

Question 9

symptoms of ascending aortic aneurysm

Answer 9

• compression-swelling head/arms
• pain: chest, neck, back
• hoarseness
• valve regurgitation

Question 10

symptoms of arch and descending aortic aneurysm

Answer 10

• wheezing, cough, SOB
• hemoptysis
• Hoarseness (RLN)
• dysphagia
• chest or back pain

Question 11

management of thoracic aortic aneurysms

Answer 11

1. beta blockers: decrease force of ejection
2. angiotensin II receptor blockers

Question 12

thoracic aortic aneurysms wider than what is an absolute indication for surgical/endovascular indications

Answer 12

5-6cm

Question 13

Type A thoracic aortic dissection

Answer 13

Ascending aorta

• 75% of cases

Question 14

Type B thoracic aortic dissection

Answer 14

Descending aorta

Question 15

aortic dissection: potential signs and symptoms

Answer 15

• chest pain
• back pain (particularly between shoulder blades)
• HTN in 2/3 patients

Question 16

Aortic dissections usually occur where

Answer 16

thoracic aorta

Question 17

initial medical management of aortic dissection

Answer 17

• Beta blockers -> decrease force of ejection
• then vasodilators like Nipride -> reduce systolic BP

Question 18

how is abdominal aortic aneurysms diagnosed

Answer 18

ultrasound

Question 19

management of abdominal aortic aneurysms less than 5/5 cm, not enlarging rapidly, asymptomatic

Answer 19

ultrasound follow-up every 6-12 months

Question 20

what are the indications for intervention of abdominal aortic aneurysms

Answer 20

• > 5.5 cm
• symptomatic
• rapid expansion: > 0.5 cm in 6-12 months

Question 21

ruptured AAA associated with what symptoms

Answer 21

• abdominal pain
• pulsatile abd mass
• tenderness
• hypotension

Question 22

AAA treatment

Answer 22

• resection and tube graft placement
• endovascular stent graft, often bifurcated: preferred

Question 23

treatment of chronic aorto-iliac occlusive disease

Answer 23

• aortic bypass surgery
• endovascular: angioplasty +/- stenting

Question 24

presentation of acute aorto-iliac occlusive disease

Answer 24

absent femoral pulses

Question 25

treatment of acute aorto-iliac occlusive disease

Answer 25

\*\*\*emergency 1. quick imaging 2. operate

Question 26

characteristics of what condition? * asymptomatic * "intermittent claudication" * critical leg ischemia-limb threat

Answer 26

peripheral arterial disease

Question 27

what is the most common form of PVD? what is it caused by?

Answer 27

* peripheral arterial disease * atherosclerosis

Question 28

Name the symptoms of peripheral vascular disease

Answer 28

1. claudication 2. rest pain 1. toes and dorsum of foot 3. Leriche syndrome

Question 29

what is Leriche syndrome present with

Answer 29

\*\*aortoiliac disease * decreased femoral pulses * impotence * buttocks and thigh claudication * numbness and cold feeling develop as disease progresses

Question 30

clinical presentation * hair loss on leg/foot * atrophic skin; nail changes * ulcers

Answer 30

chronic arterial insufficiency

Question 31

ankle brachial index. What is it and what it is used for? what is a normal value?

Answer 31

* ABI = ankle systolic pressure / brachial systolic pressure * normally \> or = to 1.0 * 95% sensitivity for chronic arterial insufficiency

Question 32

most common sites affected with chronic arterial insufficiency

Answer 32

* superficial femoral * popliteal

Question 33

what is the main symptom of chronic arterial insufficiency

Answer 33

* claudication * ischemic pain (crampy, tightening sensation) in the lower legs when walking * pain resolves within minutes of stopping to rest * most common in calves, less frequent in buttocks and thighs

Question 34

claudication is usually associated with activity. Define the distance able to walk

Answer 34

* \> 2 blocks = mild * one block = moderate * \< 1 block = severe

Question 35

why do 65-70% of claudication symptoms remain stable or improve with time

Answer 35

development of collateral vessels

Question 36

if you have claudication, what other conditions would make the prognosis worse

Answer 36

* diabetes * smoking

Question 37

List Ankle Brachial index assesment of disease severity

Answer 37

* \> or = 1: normal * 0.70-0.99: mild * 0.50-0.69: moderate * \< 0.50: severe

Question 38

Name the various AB index that are associating with the following symptoms: no claudication, claudication, rest pain, limb threat

Answer 38

* no claudication: \> 0.8 * claudication: 0.5-0.8 * rest pain: 0.2-0.49 * limb threat: \< 0.2

Question 39

in diabetic patients with calcified vessels, the ABI may change how?

Answer 39

be falsely high * if \> 1.1 think non-compressible vessels

Question 40

first therapy for claudication

Answer 40

stop-start walking regimen * regular daily walks 30-45 min/day * at least 3 x/week for at least 6 months

Question 41

therapy for claudication class I

Answer 41

1. smoking cessation 2. lipid-lowering therapy 3. aspirin

Question 42

what bypass graft is most common for femoral-popliteal revascularization

Answer 42

Goretex graft

Question 43

presentation * leg pain worsens with standing * leg swelling * varicosities * worsens as day progresses

Answer 43

venous insufficiency

Question 44

what are the 5 P's of acute obstruction

Answer 44

* Pain * Pallor * Paresthesia * Paralysis * Pulselessness

Question 45

compartment syndrome. List the 6 presenting P's

Answer 45

commonly seen after reperfusion of ischemic limb, typically calf * Pain out of proportion to finding * Passive stretch pain * Paresthesias * Pokliothermia: abn temp regulation * Paralysis * Pulselessness

Question 46

treatment of compartment syndrome

Answer 46

fasciotomy

Question 47

surgical treatment of varicose veins

Answer 47

* sclerotherapy * laser therapy * vein stripping

Question 48

first line management of varicose veins

Answer 48

1. limb elevation 30 min 3-4 x/day to decrease edema 2. compression therapy