Pathophysiology of Intermittent Claudication
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Questions and Answers

Which arteries are most commonly affected by the atherosclerotic process?

  • Iliac and radial
  • Carotid and vertebral
  • Femoral and popliteal (correct)
  • Brachial and ulnar

    • What is the primary location of pain in intermittent claudication?

  • Calf (correct)
  • Knee
  • Buttocks or thighs
  • Ankle

    • What is the initial step in the endothelial injury theory of atherosclerosis pathogenesis?

  • Proliferation of smooth muscle cells
  • Endothelial injury by risk factors (correct)
  • Diffusion of free cholesterol into extracellular spaces
  • LDL influx and binding to Glycosaminoglycans

    • What is the result of modified LDL production in the endothelial injury theory?

    <p>Inflammatory response</p> Signup and view all the answers

    What is the outcome of plaque formation and plaque fracture in the endothelial injury theory?

    <p>Thrombosis</p> Signup and view all the answers

    What is the characteristic of pain in intermittent claudication?

    <p>Pain that develops with exercise and is relieved with rest</p> Signup and view all the answers

    What is rest pain a characteristic of?

    <p>Critical leg ischemia</p> Signup and view all the answers

    What is critical leg ischemia defined as?

    <p>The subgroup of patients with symptomatic lower extremity arterial disease</p> Signup and view all the answers

    What is the most common cause of chronic arterial occlusive disease of the extremities?

    <p>Atherosclerosis</p> Signup and view all the answers

    What is the characteristic of pain in intermittent claudication?

    <p>Pain that develops in the affected limb with exercise and is relieved with rest</p> Signup and view all the answers

    What is the prevalence rate of intermittent claudication in women above 50 years?

    <p>2.5%</p> Signup and view all the answers

    Why do diabetics have a higher rate of lower extremity amputation?

    <p>Both A and B</p> Signup and view all the answers

    What is the effect of a fasting cholesterol level >270 mg/dL on the incidence of intermittent claudication?

    <p>It doubles the incidence of intermittent claudication</p> Signup and view all the answers

    What is the association between hypertension and lower extremity arterial disease?

    <p>There is a linking between hypertension and lower extremity arterial disease</p> Signup and view all the answers

    What percentage of patients with lower extremity arterial disease have hyperlipidemia?

    <p>Almost 50%</p> Signup and view all the answers

    Why is smoking a strong risk factor for development of lower extremity arterial disease?

    <p>The exact reason is not known</p> Signup and view all the answers

    What is the primary cause of chronic ischemia of extremities?

    <p>Atherosclerosis</p> Signup and view all the answers

    What is the result of arterial narrowing or obstruction in chronic ischemia of extremities?

    <p>Reducing blood flow to the limb during exercise or at rest</p> Signup and view all the answers

    What is the primary goal of thrombolysis in the treatment of acute thrombosis?

    <p>To dissolve the clot</p> Signup and view all the answers

    What is the indication for thrombolysis in the treatment of acute thrombosis?

    <p>Viable or marginally threatened limb</p> Signup and view all the answers

    What is the consequence of refusing amputation in a patient with irreversible ischemia?

    <p>Mortification of the affected limb</p> Signup and view all the answers

    What is the type of thrombolysis that involves the use of a catheter to deliver the thrombolytic agent?

    <p>Catheter-directed thrombolysis</p> Signup and view all the answers

    What is the name of the quote that highlights the importance of surgical intervention in patients with irreversible ischemia?

    <p>George Bernard Shaw's quote</p> Signup and view all the answers

    What is the term used to describe the spectrum of symptoms that result from chronic ischemia of extremities?

    <p>Spectrum of ischemic symptoms</p> Signup and view all the answers

    Study Notes

    Intermittent Claudication

    • Pain of intermittent claudication is most often localized to the calf due to superficial femoral and popliteal arteries being commonly affected by atherosclerosis
    • Distal aorta and its bifurcation are the next most frequent sites of involvement, which can produce pain in the buttocks, thighs, and legs

    Pathogenesis of Atherosclerosis

    • Endothelial injury theory:
      • Injury leads to alteration of endothelial properties
      • LDL influx and binding to Glycosaminoglycans (GAG) in sub-endothelium
      • Modified LDL produces inflammatory response
      • Proliferation of smooth muscle cells, thickening of arterial wall, and narrowing of arterial lumen
      • Diffusion of free cholesterol into extracellular spaces, plaque formation, and plaque fracture leading to thrombosis

    Clinical Picture

    • Symptoms:
      • Asymptomatic arterial insufficiency
      • Symptomatic disease presenting as intermittent claudication (pain that develops with exercise and is relieved with rest)
      • Rest pain that increases at night and decreases with dependency and rubbing
      • Critical leg ischemia, which endangers part or all of the lower extremity
    • Conditions associated with lower extremity arterial disease:
      • Arteritis (Thrombangitis obliterance, Rheumatoid arthritis, Systemic lupus erythematosis, Scleroderma, Kawasaki syndrome, Takayasu syndrome)
      • Vasospastic diseases (Reynaud's disease, Reynaud's phenomena)
      • Chronic on top of acute disease

    Risk Factors

    • Age: incidence of lower extremity arterial disease increases with age
    • Male Gender: prevalence of intermittent claudication in women > 50 years is approximately 2.5%
    • Diabetes Mellitus and Impaired Glucose Tolerance: diabetics have a sevenfold higher rate of lower extremity amputation
    • Smoking: strong risk factor for development of lower extremity arterial disease
    • Hypertension: linked to lower extremity arterial disease
    • Hyperlipidemia: almost 50% of patients with lower extremity arterial disease have hyperlipidemia

    Atherosclerosis

    • Most common cause of chronic arterial occlusive disease of the extremities
    • Arterial narrowing reduces blood flow to the lower limb >upper limbs
    • Intermittent claudication denotes pain that develops in the affected limb with exercise and is relieved with rest

    Treatment

    • Unfractionated heparin or Low-Molecular-Weight Heparin (LMWH)
    • Oral anticoagulation
    • Open surgical treatment:
      • Embolectomy/thrombectomy
      • Bypass
    • Thrombolysis:
      • Indications: viable or marginally threatened limb, recent acute thrombosis
      • Types: systemic, catheter-directed
      • Agents: streptokinase, urokinase, tissue plasminogen activator (TPA)
      • Contraindications: absolute and relative

    Chronic Ischemia of Extremities

    • Definition: arterial narrowing or obstruction resulting in reduced blood flow to the limb during exercise or at rest
    • Etiology:
      1. Atherosclerosis

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    Description

    This quiz covers the pathogenesis of intermittent claudication, including the affected vessels and resulting pain locations. Understand the endothelial injury theory and its relation to atherosclerosis.

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