Peripheral Arterial Disease Flashcards
Peripheral Arterial Disease
Arteries become narrowed and blood flow decreases in arteriosclerosis. A build up of fatty substances in the wall of the artery.
Peripheral Vascular Disease
This refers to diseases of blood vessels outside the heart and brain.
It’s often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys.
Functional peripheral vascular diseases
Do not have an organic cause. They don’t involve defects in blood vessels’ structure. They’re usually short-term effects related to “spasm” that may come and go. Reynaud’sdisease is an example. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.
Organic peripheral vascular diseases
Caused by structural changes in the blood vessels, such as inflammation and tissue damage. Peripheral artery disease is an example. It’s caused by fatty buildups in arteries that block normal blood flow.
Arterial Symptoms
Pain: Aching to sharp brought on by exercise; relieved by rest.
Pulses: Diminished or absent.
Edema: None
Skin Changes: Cold, dry, shiny, hairless. Pallor when elevated, red when dangling.
Venous Symptoms
Pain: Aching, to cramp like; relieved by activity or elevating extremity.
Pulses: Usually present.
Edema; Present, increases at the end of the day.
Skin changes: Warm, thick, tough, darkened, stasis ulcers.
Thrombophlebitis
Formation of a venous clot depends on the
presence of at least of one of
Virchow’s triad factors
-Hemodynamic changes-Venous stasis
-Injury to vessel wall (Endothelial injury)
-Hypercoagulable state
Superficial Thrombophlebitis
Thrombosis can occur in any superficial vein primarily the saphenous vein and its tributaries
Local pain, redness, and tenderness are characteristic findings.
Mild cases can be treated with warm compresses, analgesia and elastic supports
Severe cases can be debilitating and should be managed by bed rest, elevation of extremity, support stockings, and analgesia.
Antibiotics and anticoagulants are useful in septic thrombophlebitis.
Incidence of DVT from extension of a superficial clot is 3%.
Most clots in great saphenousf vein will extend into a deep vein system in a week or so thus a follow-up Ultrasound is guaranteed
Definite treatment is ligation and excision of affected vein.
Peripheral Artery Disease (PAD)
a condition similar to coronary artery disease and carotidartery disease
fatty deposits build upin theinner linings oftheartery walls
restrict blood circulation, mainly in arteries leading to the kidneys, stomach, arms, legs and feet.
common symptom is cramping or fatigue in the legs and buttocks during activity.
cramping subsides when the person stands still. This is called “intermittent claudication.“
often have fatty buildup in the arteries of the heart and brain
Because of this association, most people with PAD have a higher risk of death from heart attack and stroke.
PAD Risk Factors
Older age (> 40 years) Male gender Smoking Diabetes mellitus Hyperlipidemia Hypertension Hyperhomocysteinemia
PAD Indicative of Systemic Atherosclerosis
40-60% of patients with intermittent claudication have concomitant CAD
Prevalence of cerebrovascular disease in intermittent claudication patients is 25-50%
60% of people with PAD have CAD or cerebrovascular disease or both
40% of those with coronary or cerebrovascular disease will also have PAD
Cost $21 billion / year
Treatment of PAD
Risk factor modification Exercise therapy Antiplatelet therapy Medical therapy targeted at symptoms Revascularisation procedures Trental no longer the drug of choice Pletal, plavix
Risk Factors for DVT
Trauma, travel Hyper-coagulable, hormone replacement Recreational drugs(IV drugs) Old (age >60 yrs) Malignancy Birth control, blood group A Obesity, obstetrics Surgery, smoking Immobilization Lupus
Deep Vein Thrombosis
Clinical exam is unreliable for detection or exclusion of a DVT
Pain, redness, swelling, and warmth are present in less than half the patients with confirmed DVT.
Pain in calf with dorsi-flexion of ankle with the leg straight (Homan’s sign) may be unreliable
Symptomatic DVT will be in popliteal or more proximal veins more than 80%
DVT Treatment
Ultrasound D-Dimer Bedrest Elevation of extremity Limit vitamin K in diet Umbrella Anticoagulation Heparin then Coumadin, Xarelto, Eliquis, Pradaxa, Savaysa Low molecular weight heparin- Lovenox
