24 Questions
What is the primary justification for screening for disease in other arterial beds for patients with PAD?
To reduce the risk of MI, stroke, or death through revascularization
What is recommended for patients with PAD who smoke cigarettes or use other forms of tobacco?
Advice to quit smoking at every visit and assistance in developing a quit plan
What is the goal of coordinating glycemic control for patients with PAD and diabetes mellitus?
To reduce limb-related outcomes
What is the relationship between atherosclerosis in the coronary, carotid, and renal arteries and PAD?
Atherosclerosis is more prevalent in patients with PAD
What is the primary goal of medical therapy for patients with PAD?
To modify atherosclerosis risk factors
What is the class of recommendation for advising patients with PAD to quit smoking?
Class I, Level of Evidence A
What is the recommended approach for patients with PAD who smoke cigarettes?
Combination of medication and counseling
What is the benefit of glycemic control in patients with PAD and diabetes mellitus?
Reduced limb-related outcomes
What is recommended for patients with Peripheral Artery Disease (PAD)?
Annual influenza vaccination
What is a characteristic of a supervised exercise program for PAD?
Directly supervised by qualified healthcare provider(s) for at least 30 minutes per session
What is the primary goal of an interdisciplinary care team for PAD?
To assist in the evaluation and management of patients with PAD
How often should a supervised exercise program for PAD be performed?
At least 3 times a week
What is the primary difference between a supervised exercise program and a structured community- or home-based exercise program?
The level of supervision by healthcare providers
What is the purpose of warm-up and cool-down periods in a supervised exercise program for PAD?
To reduce the risk of injury
What is the minimum duration of a supervised exercise program for PAD?
12 weeks
What is the goal of exercise therapy in patients with PAD?
To reduce claudication symptoms
What is the primary classification of Peripheral Vascular Disease (PVD)?
Functional and Organic PVD
Which of the following is a risk factor for developing Peripheral Arterial Disease (PAD)?
History of smoking
What is the primary purpose of angiography in PAD diagnosis?
To provide information on arterial stenoses or occlusion
What is the diagnostic significance of a systolic BP < 55 mm Hg in patients without diabetes?
Ischemic lesions are unlikely to heal
What is the significance of a TcO2 level < 40 mm Hg (5.32 kPa) in PAD diagnosis?
Predictive of poor healing
What is the treatment option for arterial stenoses?
Surgical correction or percutaneous transluminal angioplasty (PTA)
Which of the following is a noninvasive alternative to catheter contrast angiography?
Magnetic resonance angiography
What is the significance of a TcO2 level < 20 mm Hg (2.66 kPa) in PAD diagnosis?
Consistent with critical limb ischemia
Study Notes
Asymptomatic Atherosclerosis Screening
- Prevalence of atherosclerosis in coronary, carotid, and renal arteries is higher in patients with PAD than those without PAD.
- Intensive atherosclerosis risk factor modification is justified in patients with PAD, regardless of disease presence in other arterial beds.
- No evidence suggests that screening for asymptomatic atherosclerosis in other arterial beds improves clinical outcomes.
Medical Therapy for PAD
- Antiplatelet, statin, antihypertensive agents, and oral anticoagulation are recommended for patients with PAD.
- Smoking cessation is crucial for patients with PAD, with assistance in quitting through pharmacotherapy and/or referral to a smoking cessation program.
- Glycemic control is beneficial for patients with PAD, particularly those with CLI, to reduce limb-related outcomes.
Peripheral Arterial Diseases
- Peripheral vascular disease (PVD) is a blood circulation disorder that causes blood vessels outside the heart and brain to narrow, block, or spasm.
- Two main types of PVD exist: functional PVD (no physical damage to blood vessels) and organic PVD (changes in blood vessel structure).
Patients at Increased Risk of PAD
- Age ≥65 years
- Age 50-64 years with risk factors for atherosclerosis (e.g., diabetes, smoking, hyperlipidemia, hypertension) or family history of PAD
Diagnosis and Assessment
- Patients with suspected PAD may undergo additional tests (e.g., Doppler ultrasonography, toe cuff measurement) to check for arterial stenosis or occlusions.
- Ischemic lesions are unlikely to heal when systolic BP is <55 mm Hg (non-diabetics) or <70 mm Hg (diabetics).
- Transcutaneous oximetry (TcO2) can assess peripheral arterial insufficiency, with levels <40 mm Hg predictive of poor healing and <20 mm Hg consistent with critical limb ischemia.
- Angiography provides details on the location and extent of arterial stenoses or occlusion.
Medical Therapy for PAD (continued)
- Annual influenza vaccination is recommended for patients with PAD.
- Structured exercise programs, either supervised or community/home-based, are beneficial for patients with PAD.
Exercise Programs
- Supervised exercise programs involve intermittent walking exercise under healthcare provider supervision.
- Structured community- or home-based exercise programs are self-directed with guidance from healthcare providers.
Learn about the prevalence of atherosclerosis in coronary, carotid, and renal arteries, and the justification for screening and risk factor modification in patients with PAD.
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