PAD & Chronic Venous Insufficiency (ABI)

Question 1

What is a common complaint of a patient with Peripheral Vascular Disease?

Answer 1

Leg Pain

Question 2

What is Peripheral Artery Disease (PAD)?

Answer 2

Arterial Disease (Atherosclerosis)

Question 3

What is Chronic Venous Insufficiency?

Answer 3

Venous Disease (Valve Problems)

Question 4

What are some artery sites of high probability of Arterial Disease?

Answer 4

Iliac Artery, Femoral Artery, Posterior Tibial Artery

Question 5

What are some complications that arise with Atherosclerosis?

Answer 5

Narrowed Lumen (Ischemia)
Thrombosis (Infarction)
Weakened Vessel Walls (Aneurysms)

Question 6

Aortic Aneurysms are likely to rupture when they are how big?

Answer 6

6cm or greater?

Question 7

If a patient has an Aortic Aneurysm, what are some of the immediate symptoms?

Answer 7

• Mid-Abdominal Pain (w/ Exertion)
• Elevated BP
• Pulsating Mass in Lower Abdomen

Question 8

What are some clinical presentations of PAD?

Answer 8

Intermittent Claudication
Atypical Lower Extremity Pain
Threatened Limb (Ischemia)

Question 9

What is Intermittent Claudication?

Answer 9

A reproducible discomfort of a defined group of muscles that is induced by exercises & relieved by rest.

Question 10

What are common sites of Intermittent Claudication?

Answer 10

Hip, Thigh, Calf

Question 11

What is Atypical Lower Extremity Pain?

Answer 11

Pain lasting longer than 10m AFTER cessation of physical activity.

Pain that occurs both at Rest AND Exertion.

Question 12

How long does Acute Limb Ischemia typically take to develop & after what type of event?

Answer 12

Thromboembolism > 2 wks > Acute Limb Ischemia

Question 13

How long does Chronic Limb Ischemia typically take to develop & after what type of event?

Answer 13

Arterial Stenosis or Occlusions > more than 2wks > Chronic Limb Ischemia

Question 14

What are some other symptoms of PAD?

Answer 14

• Reduced/Absent Pulses Distal to claudication.
• Burning, Ischemic pain @ rest (aggravated by elevating extremity)

Question 15

How is PAD diagnosed?

Answer 15

Abnormal arterial examination / tissue loss w/ rest pain and/or absence of pulse.

Question 16

What is Ankle-Brachial Index (ABI)?

Answer 16

Ratio of SBP in ankle to SBP in the arm?

Question 17

What ABI value indicates arterial occlusion (PAD)?

Answer 17

< 0.90

Question 18

What is a borderline value for an ABI index?

Answer 18

0.91 - 0.99

Question 19

What is a normal range value for an ABI index?

Answer 19

1.00 - 1.29

Question 20

How is PAD treated?

Answer 20

Smoking Cessation
Diet
Exercise Therapy

Question 21

What are PAD Aerobic FITT Recommendations?

Answer 21

F: 3-5 days/wk
I: 40-59% VO2R (to point of pain)
T: 30-45 min/day > progress to 60min/day
T: Weight Bearing Cardio

Question 22

What are PAD Resistance Training FITT Recommendations?

Answer 22

F: 2 days/wk (non-consecutive)
I: 60-80% 1RM
T: Whole Body (lwr limb emphasis)
T: 6-8 exercises, 2-3 sets ea., 8-12 reps

Question 23

What are the PAD Flexibility FITT Recommendations?

Answer 23

F: 2-3 days/wk (daily most effective)
I: Point of tightness of discomfort
T: 10-30s static hold / x2-4 reps ea.
T: Static, Dynamic, PNF

Question 24

What are some vein-related conditions?

Answer 24

Teleangiectasias / Reticular veins (spider) & Varicose veins

Question 25

Chronic Venous Insufficiency is the presence of what?

Answer 25

Skin changes, Edema, or Ulceration.

Question 26

Venous Hypertension constitutes what?

Answer 26

Inadequate muscle pump function
Incompetent venous valves (venous reflux)
Venous Obstruction

Question 27

What are some physical symptoms of Chronic Venous Insufficiency?

Answer 27

Pain (after exercises), Leg Heaviness, Swelling, Dry Skin, Muscle Cramps.

Question 28

What are some clinical signs of Chronic Venous Insufficiency?

Answer 28

Dilated veins (c1-c2)
Edema (c3)
Lipodermatosclerosis (c4)
Ulceration (c5)