Peripheral Arterial Disease Flashcards
What is PAD?
includes disorders that obstruct arterial blood flow, excluding the coronary and intracranial circulations.
What are several stages in the severity of PAD in the lower limb?
- Intermittent claudication: pain, usually in the calf, that is precipitated by walking
- Rest pain: pain, usually in the foot, that is worse elevated in bed at night and is relieved by lowering the leg
- Arterial ulceration of the leg and foot
- Gangrene of the leg and foot
What are the signs of PAD on inspection/’look’?
- Skin pallor, dryness and discoloration
- Loss of hair
- Fissuring of nails
- Venous guttering (the veins of the limb appear as shallow grooves or gutters, especially in the elevated limb - less blood coming in, therefore less blood in veins)
- Ulceration
- Gangrene
What are the signs of PAD on ‘feel’?
- Capillary refill time
- HR and rhythm
- Peripheral pulses
- Skin temperature (cool foot in advanced arterial disease)
- Abdominal palpation for abdominal aortic aneurysm (AAA) - with flat hand
What is Buerger’s test?
This used to assess the adequacy of the arterial supply to the leg. It is performed in two stages.
• With the patient supine, elevate both legs to an angle of 45 degrees and hold for one to two minutes. Observe the color of the feet. Pallor indicates ischaemia. It occurs when the peripheral arterial pressure is inadequate to overcome the effects of gravity. The poorer the arterial supply, the less the angle to which the legs have to be raised for them to become pale.
• Then sit the patient up and ask them to hang their legs down over the side of the bed at an angle of 90 degrees. Gravity aids blood flow and colour returns in the ischaemic leg. The skin at first becomes blue, as blood is deoxygenated in its passage through the ischaemic tissue, and then red, due to reactive hyperaemia from post-hypoxic vasodilatation.
• Both legs are examined simultaneously as the changes are most obvious when one leg has a normal circulation.
PAD = Beurger’s +ve
