Arterial, Venous, and Lymphatic Disease Lecture PDF

Arterial, Venous, and Lymphatic Disease Sylvia Marshall | [email protected] Academic Medicine Scholar, OMS III Gregory Saggio, DO | [email protected] Associate Professor, Department of Clinical Specialties Session Objectives 1. Establish a general approach to the vascular patient. 2. Recognize t...

Arterial, Venous, and Lymphatic Disease Sylvia Marshall | [email protected] Academic Medicine Scholar, OMS III Gregory Saggio, DO | [email protected] Associate Professor, Department of Clinical Specialties Session Objectives 1. Establish a general approach to the vascular patient. 2. Recognize the clinical presentation of arterial, venous, and lymphatic disorders. 3. Understand the complications of arterial, venous, and lymphatic disorders. 4. Synthesize the proper workup for patients presenting with arterial, venous, and lymphatic disease. 5. Understand and appreciate therapeutic options and algorithms in the treatment of arterial, venous, and lymphatic disorders. Approach to the Vascular Patient – History Taking Clinical History (timing is very important) Pain, weakness in the extremities Neurosensory complaints (warmth, numbness, hypersensitivity) Discoloration, swelling, tissue loss/ulceration, varicosities Medical History Hypertension Atherosclerotic disease (CAD, PAD, CVA, carotid stenosis) Hyperlipidemia Diabetes mellitus Surgical History Everything Social History Smoking Bates’ Guide to Physical Examination & History Taking, 12e Approach to the Vascular Patient – Physical Exam Inspection Meticulous inspection and documentation of skin changes Atrophy, cyanosis, ulceration, hair loss, abnormal nail growth Pictures are often taken to monitor wound care Palpation of pulses Unilateral: Abdominal aorta Bilateral: carotid, brachial, radial, ulnar, femoral, popliteal, posterior tibial, & dorsalis pedis arteries Auscultation & Ultrasound Auscultate for carotid & renal bruits (indicative of turbulent flow) Screening ultrasound for abdominal aortic aneurysm (AAA) Follow-up ultrasound for: Patients with known or suspected vascular disease Patients following a vascular intervention Bates’ Guide to Physical Examination & History Taking, 12e Approach to the Vascular Patient – Physical Exam  Approach to the Vascular Patient – Pulse Exam Femoral  Midway between ASIS and pubic tubercle Popliteal  Popliteal fossa, knee at 45° angle, with two hands Posterior tibial  2 cm posterior to medial malleolus Dorsalis pedis  1 cm lateral to extensor hallucis longus tendon *Always compare sides* Bates’ Guide to Physical Examination & History Taking, 12e Arterial Disease Aorta (covered in another lecture) Aneurysm: dilation, can lead to rupture Dissection: intimal tear  creation of false lumen Peripheral arteries (typically limbs) Peripheral artery disease (PAD) Aneurysm (MC = popliteal, 2nd = femoral) Extra-cranial cerebrovascular arteries Carotid stenosis Vertebral artery compression Visceral arteries (renal, splanchnic, & mesenterics) Stenosis, occlusion, aneurysm, vasculitides Sabiston Textbook of Surgery, 20e Peripheral Arterial Disease (PAD) Obstruction or deterioration of arteries other than those supplying the brain or the heart. Commonly affects the lower extremity. Major pathophysiologic process is atherosclerosis Patients typically present with claudication (pain with activity, that is relieved by rest, and reproducible with the same level of activity) +/- a non-healing wound Affects 20% of Americans ≥65 years old Increased risk with obesity, non-white ethnicities, smoking, diabetes, HTN and HLD (same risk factors as atherosclerosis) Sabiston Textbook of Surgery, 20e Image: Osmosis Pseudoclaudication Claudication vs pseudoclaudication Pseudoclaudication: Leg pain caused by nerve impingement (spinal stenosis) rather than arterial obstruction. Aka neurogenic claudication. Variable walking distances Positional relief (leaning forward) Sabiston Textbook of Surgery, 20e PAD – Clinical Presentation Patients typically present with claudication: pain with activity, that is relieved by rest, and reproducible with the same level of activity. Image: Osmosis Diagnosis of PAD – Ankle-Brachial Index (ABI) Ankle-Brachial Index (ABI) is a ratio of ankle pressure to systemic (brachial) pressure. BP cuff is inflated until pulse becomes inaudible via doppler Perform at posterior tibial, dorsalis pedis and brachial arteries Use the highest brachial pressure overall (systolic), and the highest ankle pressure per limb. Sabiston Textbook of Surgery, 20e  Diagnosis of PAD – Ankle-Brachial Index (ABI) ABI of