11 17 2014 Peripheral Arterial Occlusive Disease

Question 1

Peripheral Arterial Occlusive Disease

Answer 1

Presence of flow-limiting lesion in an artery that provides blood supply to the limbs

Question 2

Etiology of Peripheral atherosclerotic vascular disease

Answer 2

Eitology:

1. Atherosclerosis (most common)
2. Thormboembolism
3. Vasculitis

15-20% of patients are over the age of 70
40% of people with PAD have clinically significant CAD

Question 3

Atherosclerotic limb

Answer 3

At rest: BP at ankle is less than that of a healthy person

With exertion the reduction in pressure produced by atherosclerotic lesion becomes more significant and the distal pressure is greatly diminished.

Stenotic vessel cannot supply enough blood to limb that has an increase demand ( exercise)

Atherosclerotic endothelium does not release normal amounts of vasodilating substances
- stenosis plus decrease in vasodilating substances = ischemia

Question 4

Clinical Presentation of Atherosclerotic Limb

aka what patients complain of

Answer 4

• Pain with exertion (claudication)
• correlates to blocked artery
• usually goes away with rest (2-3min)
• Rest pain (sever – limb threatening ischemia)
• Non-healing wounds ( due to inadequate blood supply)

Question 5

Muscle adaptation to ischemia

Answer 5

• denervation

- muscle wasting and strength is decreased

Question 6

Clinical signs of atrial insufficiency

aka what you will see

Answer 6

Atrophy of calf muscles
Thickened toes
Loss of hair below the knees
Thin, shiny skin
Non-healing wounds
Dependent rubor

Question 7

Ankle- Brachial Index

Answer 7

Cuffs at arms and ankles – ratio between Ankle/Arm pressure

normally: ankle pressure is higher than arm pressure

Exercise begins, no change in measured blood pressure occurs in the healthy extremity

<.5 ratio

Question 8

Acute Limb Ischemia – Five P’s

Answer 8

Pain
Pulseless
Paresthesias
Paralysis
Poikylothermia

Question 9

Neurogenic claudification

1. cause
2. how to relieve pain and what causes the pain
3. Symptoms?
4. What are the areas usually affected?
5. History key points?

Answer 9

Spinal Stenosis

• Pain is relieved when the patient flexes the spine by sitting. (or just changing positions)
• ischemia of nerve roots + narrowing of spinal canal

Presents:
symptoms as claudication OR tingling, weakness, or clumsiness

Areas: buttock, hip, thigh

History: lower back pain problems in the past