Peripheral Arterial And Venous Disease Flashcards
What is the normal cause of the PAD
Occlusions
Atherosclerosis
Thombus
Embolism
What would be the flow when have a PAD
Turbulent
Reduced flow to the muscles during exercise
So would normally have pain during exercise which would be relieved with rest
What is intermittent claudication
Pain, cramping or a sense of fatigue in a muscle group of the lower extremities
Would occur in exercise but would be relieved when rest
What artery’s would be obstructed when have a buttock-hip-thigh claudication
Aorta or iliac artery
What artery would be effected when have a calf claudication
Superficial femoral artery
What artery would be effected when have a calf-ankle-foot claudication
Popliteal artery or distal artery’s (could be on the dorsal foot)
What are the signs of the acute or chronic limb ischemia
Rest pain
Ulceration
Gangrene
Limb loss
What are the features of the acute limb ischemia (sudden onset)
6 P’s
P = pallor
P = paraesthesia (pins and needles)
P = paralysis
P = pain
P = Pershing cold
P = pulselessness
What is critical limb ischaemia
Severely impaired flow to the lower limbs, would the increased risk of limb loss
What is chronic and limb threatening ischaemia
Most severe decrease in the limb perfusion
Pain at rest
Normally would come with an amputation
What would be part of the physical examination of the limbs
Skin (pallor, scars, ulcers)
Soft tissues (swelling, muscle wasting)
Bone (deformity’s, fractures and amputations)
What is the Buergers test
A) raise the leg for 3 mins at a 45 degree angle. If have paleness would have an issue
B) dangle the leg on the edge of a table. If have cyanosis and hyperactive hyperaemia, would be a postive test
What is the ankle brachial index
Measure the blood pressures of the arms and the ankles (posterior tibial artery and the dorsalis pedis)
Take the highest pressure out of them
What is the value for the ankle brachial index that would show a PAD
<0.9 = PAD
<0.5 = severe PAD
What is another form of diagnostic testing
Duplex ultrasound imaging
What is involved in CV Risk modification
Exercise
Lipid management
Boood pressure control
Antiplatelet agents
What treatments would aid functional capacity
Exercise therapy
Medications
Revascularisation
What would be the treatments that would be for the limb salvaging
Wound care
Antibiotic
Revasularisation
Amputation (especially when have the critical ischaemia)
What the superficial veins in the leg
Great saphenous
Small saphenous
Dorsal and plantar veins
What are the deep veins
External iliac vein
Deep femoral vein
Femoral vein
Popliteal vein
How does the musculovenous pump help the veins
Outwards expansions of the muscles when they contract would be limited by the deep fascia. This would then lead to compression on the veins
Blood pumped up
What happens to the musculovenous pump when you would have the incompetent valves
Decrease in venous pressure with leg movements is reduced
Blood can not efficiently move to the heart
What would happen when there are incompetent valves in the perforator veins
High pressures by the calf contraction would push the blood from the superficial veins to the micro circulation in the skin
What would cause the odema in the lower limbs
Venous and capillary hypertension
Also through the reflux and obstruction
Fluid would then be forced outwards
