Peripheral art disease Flashcards
general review of PAD
- usually in legs
- art. insuff. results when demand exceeds supply
- ischemia results
5 features of athero physiology
- progressive
- eccentric
- multifactorial
- in media of A
- heterogernous
5 major risk factors for PAD in order
- smoking
- DM
- age
- HT
- cholest
what does PAD affect
SYSTEMIC
** what is ACUTE ischemia
- Sx that dev. quickly and progress
- SUDDEN leg pain
- VERY VERY severe pain
what causes acute ischemia - 4
- embolus forms in one region and travels
- thrombosed A
- trauma
- acute on chronic
6 Ps of acute ischemia
Pain Pallor Paralysis Paresthesias Pulselessness Polar
***2 most important Sx of acute ischemia
Paralysis - movement
Paresthesias - sensation
** what does disrupted movement or sensation mean
- threatened extremity
- NEED TO ACT NOW
what are 2 presentation of chronic PAD
- claudication
- critical ischemia
- rest pain
- night pain
- non-helaing wounds or ulcers
what is presentation of claudicatiokn
- pain (esp calves) with excercise
- predictable - always same amount of ecercise
- goes away with rest
what is risk in claudication
low risk of limb loss
- depends on degree of the impairment
what is Sx of critical ischemia
- rest pain
- night pain
- non-helaing wounds or ulcers
what is risk of critical ischemia
HIGH risk of limb loss
- also a marker of severs athero
- likely to die in 5 years
what is importance of pulses
the harder they are, the more likely they are to have PAD
what is ABI
highest tibial P/highest brachial P
levels of ABI
normal 1.2
.5 critical ischemia
what are adv. and dis of US
adv.
- non-invasive
- can loacalize disease
- can determine physio of flow
dis.
- can be hard in abdo
- low resolution
use of US
- good for ID and following patients
- not great for planing procedures
what is angio
great resolution , but invasive
4 major common site of disease
- aorto-illiac
- femoro-pop
- tibial
- micro-circulatiokn
3 things Sx depend on
- degree of stenosis/occlusion
- time over which lesion dev.
- number of levels involved
Tx objectives
- save leg
- preserve life
- improve function
- prevent deterioration
4 treatment options
- risk factor reduction
- lot removal
- angioplasty
- bypass surgery
what is resuscitation for acute
- heparin
- rapid prep for OR
