Peripheral arterial disease Flashcards
sx for peripheral arterial disease
classic claudication (MC) - intermittent LE pain or cramping w ambulation, exercise, or movement and relieved with rest
atypical extremity pain for peripheral arterial disease
leg pain/carry on (exertion leg pain that does not cause the pt to stop walking) and leg pain on exertion and rest is exertion leg pain that may occur at rest
ischemic rest pain in peripheral arterial disease
in advanced disease
constant intractable, burning pain in the forefoot (soles of the feet)
MC at night
aggravated by elevation
relieved w foot dependency
What will you see on PE for peripheral arterial disease
pulses - decreased, weak or absent pulses, bruits, decreased cap refill. usually no edema
skin - atrophic skin changes - muscle atrophy; skin that is thin, dry, shiny. hair loss or slowed hair growth, thickened nails w slow growth, cool limbs to the tough and areas of necrosis
non healing would/ulcer - often starts as a traumatic wound that fails to heal - they are commonly found on the tops of toes and btw the digits. ischemic ulcers also form at site of increased focal pressure (lateral malleolus and metatarsal heads)
color - foot and leg pallor on elevation. dependent rubor - dusky red color of the leg when it is placed in the dependent position
normal ankle brachial index
1-1.3
ankle brachial index for PAD
< 0.9
what test can be done to evaluate further extent of vascular disease
duplex ultrasonography
what is the gold standard for peripheral arterial disease
arteriography - usually only performed if revascularization is planned
what is the most effective therapy to improve sx and increase walking distance in pts w claudication for peripheral arterial disease
cilostazol
sx chronic venous insufficiency
leg pain worsened with prolonged standing, prolonged sitting w the feet dependent
leg pain improved w ambulation and leg elevation
pain classically described as burning, aching, throbbing, cramping, or “heavy leg”
PE findings chronic venous insufficiency
stasis dermatitis - itchy eczematous rash (inflammatory papule, crusts, or scales), excoriations, weeping erosions and brownish or dark purple hyperpigmentation of the skin
venous stasis ulcers (especially at the medial malleolus)
dependent pitting leg edema, increased leg circumference, varicosities, and erythema with normal pulse and temperature
atrophie blanche - atrophic, hypo pigmented areas w telangiectasis and punctate red dots
tx for chronic venous insufficiency
compression stockings (cornerstone of tx), leg elevation, skin care, exercise, weight management
tx underlying cause
ulcer management
surgery if non responsive
