Peripheral Arterial Disease (PAD) Flashcards
PAD
atherosclerosis of arteries in limbs
it is body wide!!!
stenosis becomes significant at
75% occlusion
Risk Factors for PAD
smoking HTN DM hypercholesterolemia family history
Acute Arterial Occlusion
emergent condition that may result in irreversible ischemia
six P’s
pain pulseless paralysis paresthesia pallor poikilothermia
MC site of acute arterial occlusion
Common femoral artery
peripheral nerves affected first (peroneal n)–> decreased sensation in 1st TM, unable to dorsiflex great toe
MC cause of acute arterial occlusion
Cardiac emboli (AFIB)
Treatment of Acute Arterial Occlusion
emergent angiogram
IV heparin
embolectomy
Chronic Arterial Occlusion
intermittent claudication associated with exercise and relieved by rest
Rest pain
associated w/ significant/advanced PAD
Pt w/ advanced ischemia
pain w/ legs elevated
improved when legs dangle
MC site for chronic arterial occlusion
superficial femoral artery at hunter’s canal (Adductor canal)
distal medial thigh
Dependent Rubor
bright red coloration of feet when feet are dangled
seen in pt w/ advanced PAD
Non-invasive testing for PAD
ABI (ankle/brachial index)
PVR (pulse volume recording)
ABI
ratio of ankle to brachial pulse
normal = 1.0-1.1
claudication = 0.5–0.6
severe PAD w. risk of limb loss = 0.3
ABIs will drop after exercise in pt w/ PAD
When are ABIs not reliable
in DM
arteries become calcified and difficult to compress
can measure toe pressure in these cases
Aortoiliac Disease
intermittent claudication of butt, thighs, calves
Leriche’s Syndrome
claudication, impotence, diminished femoral pulses
Blue Toe Syndrome
seen w/ pt w/ aortoiliac disease
distal embolization derby from atherosclerotic plaques
Management of PAD
baseline ABIs antiplatelet therapy walking regimen (promote collaterals) Pletal control HTN control BS lower cholesterol
Surgery if…
toe ulcers, restpain, worsening ABI
Pletal
reversibly inhibits platelets
helps lower tris, inc HDL
mild vasodilator
100 mg PO, BID on an empty stomach
Surgical Intervention w/ PAD
Fem-Pop bypass
above knee: prosthetic graft
below knee: vein
