6. Acute Peripheral Vascular Insufficiency

Question 1

Acute Peripheral Vascular Insufficiency

Answer 1

One question about this topic may appear on exam. It generally covers ACUTE issues that are related to peripheral arterial disease (PAD) or acute symptomatic carotid artery disease.

Question 2

Peripheral Arterial Disease (PAD): signs and symptoms

Answer 2

The 6 Ps:
1. Pain (activity, rest)
2. Pallor
3. Pulse absent or diminished
4. Paresthesia
5. Paralysis
6. Poikilothermia: loss of hair on toes or lower legs; glossy, thin, cool, dry skin (chronic sign of PAD)
7. Additionally, cool to touch, minimal edema

Question 3

Peripheral Arterial Disease (PAD): ABI

Answer 3

Ankle-Brachial Index:
-Test to assess for PAD
-Used to assess the adequacy of lower extremity perfusion
-Normal is > 0.90
-Divide the ankle pressure by the brachial pressure on the same side.
**You only need to remember what a normal ABI is for the exam

Question 4

Peripheral Arterial Disease (PAD): Additional diagnostic testing

Answer 4

-Doppler ultrasound
-Arteriography

Question 5

Peripheral Arterial Disease (PAD): Pt care management for PAD

Answer 5

-Embolectomy, bypass graft, angioplasty
-Bed in reverse Trendelenburg
-Do NOT elevate the affected extremity – it will decrease perfusion

Question 6

Peripheral Arterial Disease (PAD): Medications

Answer 6

-Thrombolytics (tPA)
-Anticoagulants (heparin)
-Antiplatelet agents (ASA, clopidogrel)
-Vasodilators

Question 7

Acute Symptomatic Carotid Artery Disease: Signs and Symptoms

Answer 7

-Transient ischemic attack (TIA)
-Monocular visual distrubances
-Aphasia
-Stroke

Question 8

Acute Symptomatic Carotid Artery Disease: Diagnostic testing may include one of the following

Answer 8

-Angiography (gold standard): risk of stroke during exam
-Carotid duplex ultrasound
-Computed tomography angiography (CTA)
-Magnetic resonance angiography (MRA)

Question 9

Acute Symptomatic Carotid Artery Disease: Treatment

Answer 9

-Carotid endarterectomy (CEA)
-Carotid stenting
-Aspirin
-Statin Therapy

Question 10

Acute Symptomatic Carotid Artery Disease: Post-Procedure monitoring

Answer 10

-Frequent neurological and motor checks
-Close BP and HR monitoring: pt may experience labile BP and/or bradyarrhythmia with hypertension, hypotension, or bradycardia.
-Monitor for bleeding
-Pt may develop hyperperfusion syndrome with the signs/symptoms of a headache ipsilateral to the revascularized carotid artery, focal motor seizures, and/or an intracerebral hemorrhage.