Arterial Vascular Disorders Flashcards
PAD
Peripheral Arterial Disease
PAD
Progressive narrowing & degeneration of arteries
ALL Extremities, but more frequent in all
Leading cause of PAD
Atherosclerosis
Risk increases w/ age
Typically appears at ages 60-80
= in men & woman
Strongly r/t other CV diseases
PAD
Risk Factors for PAD
Cigarette smoking
Hyperlipidemia
HTN
DM
(PAD): Atherosclerosis - Commonly affected arteries:
More commonly affects certain portions of arterial tree Coronary Carotid Iliac Femoral Popliteal Tibial
S/s of arterial disease begin when
occlusion 60-75%
PAD in Diabetics
primarily affects:
Anterior and Posterior Tibials
Peroneal
PAD in non-diabetics
Femoral & popliteal
Intermittent claudication
Pain with exercise
Resolves with rest
Reproducible
(10% of pt)
PAD Manifestation
Intermittent claudication
Impotence
Paresthesia
Neuropathy
PAD: Complications
Decreased arterial blood flow
Non-healing ulcers over bony prominence
Gangrene then amputation
PAD - Diagnostic Testing—Non Invasive
Doppler ultrasound
Duplex imaging
Segmental blood pressures
Ankle-brachial index (ABI)
Ankle-brachial index (ABI)
Use highest brachial and then use highest L.E –> LOWER/UPPER
LOWER THE #–> WORSE OFF THE EXTREMITY
PAD: Diagnostic Studies–Invasive
Angiography and MRA
Angiogram
Contrast dye injected into a catheter in vessel
Pictures taken as dye is dispersed into system
Angiogram Complications:
Bleeding Thrombosis Arterial dissection Emboli Hematoma (cath sz) Allergic reaction Renal failure (dye hard on kidneys)
Pre-Angiography
Inform of contrast/dye side effects ( allergies?) NPO after MN prior to procedure Document pulses prior to procedure Labs Pre op medications Follow facility protocol Informed consent
Pre-Angiography Labs
PT, PTT, INR, BUN, Creatinine (kidney/dye clearance)
Post Angiography
Assess q 15 min x4, q30 min x 2, then hourly x 4: Pressure dressing Access site Distal pulses Bedrest IV fluids as ordered
Modifiable Risk Factor PAD
Smoking cessation
Tx hyperlipidemia
BP maintained <7.0%
Drug therapy PAD
Antiplatelet
Ace Inhibitors
Antiplatelet agents
Aspirin Clopidogrel (Plavix)
ACE inhibitors
Ramipril (Altace)
Ramipril (Altace)
↓ cardiovascular morbidity and mortality
↑ peripheral blood flow
↑ walking distance
Treatment of intermittent claudication (DRUGS)
Cilostazol (Pletal)
Pentoxifylline (Trental)
Cilostazol (Pletal)
↑ vasodilation
↓ platelet aggregation
↑ walking distance
Pentoxifylline (Trental)
↑ erythrocyte flexibility
↓ blood viscosity
Critical limb ischemia
Rest pain for 2 weeks
Arterial ulcers
Gangrene in affected leg
Critical limb ischemia Conservative goals:
Protect extremity from trauma
Decrease Pain
Prevent or control infection
Maximize arterial perfusion
Percutaneous Transluminal Balloon Angioplasty (PTBA)
Balloon-tipped catheter inserted through femoral artery to site of obstruction–>Inflated at narrowing
–>Cracks atherosclerotic plaque and stretches media
Best sites for Percutaneous Transluminal Balloon Angioplasty (PTBA)
iliac, femoral
Endarterectomy
Sx opening of an artery & removing the (“fatty plaque scrapple”…)
Patch Graft Angioplasty
Open artery, Remove Plaque, Apply patch to
Cover ulceration –> Widen artery lumen
Amputation used for
Gangrene
Osteomyelitis
All major arteries in limb are occluded
preserve as much of limb as possible–>last resort!
Post-op emergency
Absent pulses, decreased ABI’s, dramatic pain, cool/pale/blue skin, numbness/tingling
