Arteriosclerosis and Atherosclerosis PDF

1/16/24, 10:20 PM Realizeit for Student Arteriosclerosis and Atherosclerosis Prevention Intermittent claudication is a symptom of generalized atherosclerosis and may be a marker of atherosclerosis in other arterial territories, such as the coronary and carotid arteries. The suspicion that a high-f...

1/16/24, 10:20 PM Realizeit for Student Arteriosclerosis and Atherosclerosis Prevention Intermittent claudication is a symptom of generalized atherosclerosis and may be a marker of atherosclerosis in other arterial territories, such as the coronary and carotid arteries. The suspicion that a high-fat diet contributes to atherosclerosis means that it is reasonable to measure serum cholesterol and to begin disease prevention efforts that include diet modification. The American Heart Association recommends reducing the amount of fat ingested, substituting unsaturated fats for saturated fats, and decreasing cholesterol intake to reduce the risk of cardiovascular disease. Certain medications that supplement dietary modification and exercise are used to reduce blood lipid levels. Current evidence-based guidelines established by the American College of Cardiology and the American Heart Association (ACC/AHA) recommend 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) as first-line therapy in patients with PAD for secondary prevention and cardiovascular risk reduction (Conte, Bradbury, Kolh, et al., 2019). These statins may include medications such as atorvastatin, lovastatin, pitavastatin, pravastatin, simvastatin, fluvastatin, and rosuvastatin. Several other classes of medications used to reduce lipid levels include bile acid sequestrants (cholestyramine, colesevelam, colestipol), nicotinic acid (niacin), fibric acid inhibitors (gemfibrozil, fenofibrate), and cholesterol absorption inhibitors (ezetimibe). Patients receiving long-term therapy with these medications require close monitoring. Hypertension, which may accelerate the rate at which atherosclerotic lesions form in high-pressure vessels, can lead to a stroke, ischemic renal disease, severe PAD, or coronary artery disease. Hypertension is a major risk factor for the development of PAD and may be a more significant risk factor for women than men based on research findings from the classic Framingham Heart Study and a similar study performed in Europe (Jelani et al., 2018). The majority of patients with hypertension require more than two antihypertensive agents to reach target blood pressure, and at least one third require more than three antihypertensive agents to achieve effective blood pressure control (Sidawy & Perler, 2019). Although no single risk factor has been identified as the primary contributor to the development of atherosclerotic cardiovascular disease, it is clear that the greater the number of risk factors, the greater the risk of atherosclerosis. Elimination of all controllable risk factors, particularly nicotine use, is strongly recommended. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 1/3 1/16/24, 10:20 PM Realizeit for Student Clinical Manifestations The clinical signs and symptoms resulting from atherosclerosis depend on the organ or tissue affected. Medical Management The management of atherosclerosis involves modification of risk factors, a controlled exercise program to improve circulation and functional capacity, medication therapy, and interventional or surgical procedures. Surgical Management Vascular surgical procedures are divided into two groups: inflow procedures, which improve blood supply from the aorta into the femoral artery, and outflow procedures, which provide blood supply to vessels below the femoral artery. Inflow surgical procedures are described with diseases of the aorta and outflow procedures with peripheral artery disease. Endovascular Therapy Endovascular therapies include various procedures that use a puncture or small incision to place catheters inside a blood vessel to repair it or insert a device and have replaced a large proportion of open surgical approaches to management. If an isolated lesion or lesions are identified on imaging, angioplasty, also called percutaneous transluminal angioplasty (PTA), or an atherectomy, may be performed. After the patient receives a local anesthetic agent, a balloon-tipped catheter is maneuvered across the area of stenosis. Although some clinicians theorize that PTA improves blood flow by overstretching (and thereby dilating) the elastic fibers of the nondiseased arterial segment, most believe that the procedure widens the arterial lumen by “cracking” and flattening the plaque against the vessel wall. An atherectomy reduces the plaque buildup within an artery using a cutting device or laser. Complications from PTA and atherectomy include hematoma formation, embolus (blood clot, fatty deposit, or air that travels through the blood, lodges in an artery or vein, and blocks flow), dissection https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 2/3 1/16/24, 10:20 PM Realizeit for Student (separation of the intima) of the vessel, acute arterial occlusion, and bleeding. To decrease the risk of restenosis, stents (small mesh tubes made of nitinol, titanium, or stainless steel) may be inserted to support the walls of the artery and prevent collapse immediately after balloon deflation. A variety of stents and stent grafts may be used for short-segment stenoses. Complications associated with stent or stent graft use include distal embolization, dissection, and dislodgment. The advantage of angioplasty, atherectomy, stents, and stent grafts is a decreased length of hospital stay; many of the procedures are performed on an outpatient basis. https://herzing.realizeithome.com/RealizeitApp/Student.aspx?Token=lqf9HhURQ5RqpgqAkzH2zbfuwFjUs0mdxkPeVey4KH2F7i%2fH0LC0NH7inQLoUzK%2fM… 3/3