Gen Med: Lecture 9- Peripheral Vascular Diseases Flashcards
Peripheral Vascular Disease includes disorders of what blood vessels?
Arterial and Venous
How is PVD classified?
By underlying pathology
What are some classifications of PVD?
Arterial Occlusive
Inflammatory
Vasomotor
Venous
What are arterial thrombosis/embolisms commonly due to?
Atherosclerosis (Most common)
Vasomotor and Clotting disorders
What are the signs and symptoms of ischemia?
Pain
Numbness
Coldness
Palor
Sensation changes
Weakness
Muscle Spasm
What is an example of an inflammatory disorder leading to peripheral artery disease?
Vasculitis
How do inflammatory disorders cause peripheral vascular disease?
Results in narrowing of blood vessels or weakening of vessel wall and formation of aneurysm
What are some vasomotor disorders leading to peripheral vascular disease?
Reynaud’s disease
Complex regional pain syndrome
How do vasomotor disorders cause peripheral vascular disease?
Lead to focal areas of ischemia
What are some venous disorders that can lead to peripheral vascular disease?
Chronic venous insufficiency
Venous thromboembolism
What is chronic venous insufficiency?
Weak valves allow blood to back flow and pool
What happens as a result of chronic venous insufficiency?
Venous hypertension
Obstruction to venous flow
Veins become enlarged and weak
What causes chronic venous insufficiency?
Incompetent venous valves
Inadequate muscle action
Venous obstruction
What is post thrombotic syndrome?
Physiologic consequence of a venous thromboembolism leading to chronic venous insufficiency
What are some risk factors for chronic venous insufficiency?
Age
Genetics
Obesity
Prolonged standing
Sedentary lifestyle
Smoking
Female hormones
Pregnancy
What can be seen in individuals with venous insufficiency?
Spider veins
Varicose veins
Swelling
Skin changes
Hemosiderin staining
Chronic leg ulceration
What are the treatment methods for chronic venous insufficiency?
Promote venous return
Wound care
Medical and surgical management
What is the prognosis for chronic venous insufficiency?
Poor prognosis
What treatments should be cautioned when treating chronic venous insufficiency and why?
Compression dressing and elevation due to common comorbidities
How does pain differ in arterial and venous disorders?
Arterial: Predictable aching and cramping with activity
Venous: Aching, burning, cramping, and fatigue with standing; heaviness, night cramping, swelling, and throbbing
How does edema differ in arterial and venous disorders?
Arterial: May or may not be present
Venous: Worse at end of day, improves with elevation
How does muscle mass differ in arterial and venous disorders?
Arterial: Reduced
Venous: Unaffected
How does elevation affect arterial compared to venous disorders?
Arterial: Worsens symptoms
Venous: Lessens symptoms
How do walking exercises affect arterial compared to venous disorders?
Arterial: Aching at certain time/distance
Venous: Lessens symptoms
How do pulses differ in arterial and venous disorders?
Arterial: Decreased or absent, bruits may be present
Venous: May be difficult to palpate due to edema
How does skin color differ in arterial and venous disorders?
Arterial: Cyanotic or pale
Venous: Hyperpigmented, brown discoloration, often superior to medial malleolus
How does skin differ in arterial and venous disorders?
Arterial: Reduced hair, shiny skin, thick brittle nails
Venous: Chronic cellulitis, dermatitis, ulceration
How does skin temperature differ in arterial and venous disorders?
Arterial: Cool
Venous: May be warm with infection
How do ulcers differ in arterial and venous disorders?
Arterial: Pale base, found at high pressure sites
Venous: Near medial malleolus and gaiter area of lower leg, irregular border, pink/red base
What is a venous thromboembolism?
Partial or complete occlusion of a vein by a thrombus with secondary inflammation of the vein
What can DVTs progress to?
pulmonary emboli
Approximately what percent of venous thromboembolisms are asymptomatic?
50%
What do 80% of symptomatic VTE cases involve?
Proximal DVT
How do proximal DVTs compare to distal DVTs?
Proximal are more severe
What do 50% of people with a proximal DVT have?
PE
What is used to assess for likelihood of developing a VTE?
Padua Prediction Score
What is the tool used to predict if a DVT is present?
Well’s
What is used to assess clinical probability of a PE?
Simplified Geneva Score
What should be done before mobilizing someone with a PE?
Communicate with the medical team
What is important to keep in mind with people on prophylactic anticoagulation?
They can still develop DVTs
Should be monitored for bleeding
