Vascular Disorders

PA Study Sesh

On this week’s episode, we’ll be discussing vascular disorders. Please note that we’ll be discussing arteriovenous malformations in the neurology chapter.
Peripheral artery disease
PAD Picmonic Here!
* Pain in lower extremities increased with exercise, relieved with rest
* Called claudication
* Imagine angina for the legs
* Most commonly in the calf
* Physical exam
* Decreased pulses
* Decreased cap refill
* Atrophic skin changes
* Thin/shiny skin
* Hair loss
* Cool limbs
* Pale on elevation, dusky red with dependency (dependent rubor)
* Lateral malleolar ulcers with well-defined borders
* No artery on the lateral side
* Diagnosis
* Ankle-Brachial Index
* Ratio of BP at ankle compared to arm
* Lower BP in ankle=less blood flow=lower index
* Screening tool
* + if ABI <0.9
* Arteriography
* Gold Standard (because it SHOWS us occlusion)
* Usually only done in practice if revascularization planned
* Management
* Platelet inhibitors
* Cilostazol
* Useful for intermittent claudication
* ASA
* Clodpidogrel
* Exercise!
* Revascularization
* Angioplasty
* Fem-pop bypass
Acute Arterial Embolism
* Can be a complication of PAD
* Thrombus=originates at that spot embolus=originates elsewhere, then lodges
* 6Ps
* Paresthesias
* Pain
* Pallor
* Pulselessness
* Paralysis
* Poikilothermia
* Same as the 6Ps of compartment syndrome!
* Except these patients complain of paresthesias first (and different risk factors)
* “Cut off your circulation”=numb and tingly
* Compartment syndrome=squeeze tightly (like with a cast)=painful
* Tx: Heparin, Thrombolytics if thrombus, embolectomy if needed.
AAA
* >3.0cm
* Most often occurs infrarenally
* Risk Factors:
* Atherosclerosis #1
* Age >60
* Smoking!
* Male
* Connective tissue disorders
* Laplace’s law: larger aneurysms expand more quickly
* Symptoms:
* Often none
* Tender, pulsatile abdominal mass
* Rupture: severe back/abdominal pain, syncope, hypotension
* Diagnosis:
* Abdominal ultrasound
* Initial study of choice
* Used for monitoring (discussing in a minute)
* CT:
* thoracic aneurysms
* pre-surgical planning
* Angiography
* Gold standard (again, shows us a picture)
* Management:
* Beta blockers to decrease rupture risk
* 3-4cm: ultrasound Q1year
* 4-4.5cm: u/s Q6months
* >4.5cm: referral to vascular surgeon
* >5.5 cm or >0.5cm growth in 6 months: immediate surgical repair
Aortic Dissection
* Tear in the intima layer of the aorta
* Creates a false lumen
* Most often ascending (aortic highsections)
* Most fatal
* Risk Factors
* Hypertension
* Age 50-60
* Connective tissue disorders may present younger
* Symptoms: