PAD/PVI Flashcards
Peripheral Artery Insufficiency / Disease
Peripheral arterial insufficiency results when there is insufficient blood flow to the extremities; it includes disease of the aortoiliac, femoropopliteal, and intrapopliteal arterial segments. It is much more likely to occur in the lower extremities,
Major cause of PAD
Atherosclerosis
PAD Risk Factors
65+ years old
50-64 year old with diabetes, smoking, hyperlipidemia, HTN, family history
PAD Symptoms
Can be unique to each patient in how they describe the pain
Key of PAD Symptoms
Claudication - cramping or tightening of the vessels causing pain in the limbs during exercise / use that is relieved at rest
PAD Symptoms
Claudication Muscle, hair, or skin changes in the limbs indicating circulation compromise Dependent rubor (elevation of limb results in paleness)
PAD Diagnosis
History and Exam
Resting ABI - use dopler and BP cuff to measure pressure at which pulse is lost, significant difference between legs (0.9 or less) is suggestive.
Duplex ultrasound may also be used
ABI values
<0.9 = PAD <0.75 = claudication <0.5 = tissue loss
> 1.4 = clacification of vessels, refer to specialist
PAD and Diabetes
diabetic neuropathy can make diagnosis more difficult, may mask claudication pain
PAD Management
Depends of symptom severity
Lifestyle modifications
Structured exercise program
Higher risk patients need anti platelet therapy, HTN management, DM management
PAD referral
signs of vascular compromise
ABI <0.5
Non-healing ulcers
Refer diabetic patients to podiatry
Acute Arterial Insufficiency
Medical emergency
Sudden onset of symptoms of limb ischemia
If history of A-Fib or CVA, consider embolus
If history of vascular disease, consider acute thrombosis
Blue-Toe syndrome
Bluish discoloration of feet or other signs of vascular loss in foot
results from microemboli from the heart, aorta, or peripheral arteries that are small enough to lodge in the capillaries
Ultrasound and consult
Peripheral Venous Insufficiency
Peripheral venous insufficiency occurs whenever there is obstruction to venous return in the superficial or deep veins of the upper or lower extremities. Important clinical syndromes related to venous insufficiency include DVT, venous stasis, varicose veins, stasis dermatitis, and leg ulceration.
DVT
Blood clot in the deep veins, usually lower limbs
Phlebitis
preferred term for a superficial venous thrombus that has no risk of becoming a PE
Usually a result in superficial veins and not the deep veins
DVT Presentation
Non-specific, history and exam are key
Leg edema with calf tenderness is the classic presentation
Homan’s Sign
Calf pain on dorsiflexion of the foot, may suggest DVT
SVT Symptoms
superficial edema, erythema, tenderness over a superficial vein
SVT Management
NSAIDs
Limb elevation and compression
Heparin may be considered if concerned about DVT as well
Chronic Venous Stasis
Chronic venous stasis results from increased pressure in the deep veins. This condition produces edema, varicose veins, chronic skin changes, and potentially ulceration.
Managed with compression stockings
Venous Stasis Presentation
The clinical appearance of chronic venous stasis varies according to whether the superficial or deeper veins are affected. Chronic edema and skin discoloration on the legs and ankles may be present. Varicose veins, ulceration, and even cellulitis may result.
Varicose Veins
Distension and proliferation of superficial veins
Primary - familia
Secondary - from previous DVT
Varicose Vein Treatment
Support stockings
Severe can be referred to a specialist for ablation, laser therapy, etc.
Venous Stasis ulcers
Ulcer above the medial malleolus and signs of stasis
