Peripheral Artery Disease Flashcards
peripheral artery disease (PAD) - defined
*flow-limiting atherosclerotic disease of the arteries of the lower extremities
*most studies define PAD as Ankle Brachial Index < 0.90
*can be asymptomatic, lifestyle threatening, or limb threatening
*strongly associated with coronary artery disease, cerebrovascular disease, and all-cause mortality
Ankle Brachial Index (ABI)
*a test that measures the ratio fo blood pressure in the ankle compared to blood pressure in the arm
*used to assess the vascular status of the lower limbs & diagnose peripheral artery disease (PAD)
*ABI < 0.90 is generally considered PAD
risk factors for peripheral artery disease (PAD)
*SMOKING
*hyperlipidemia
*hypertension
*diabetes
peripheral artery disease (PAD) ASYMPTOMATIC clinical presentation
*majority of patients with PAD are asymptomatic
*collateral circulation development, adaptation of tissues to chronic ischemia
*poor functional status precludes realization of symptoms
peripheral artery disease (PAD) CLAUDICATION clinical presentation
*exertion-related muscular pain
*RELIEVED BY REST
peripheral artery disease (PAD) CRITICAL LIMB ISCHEMIA clinical presentation
*pain at rest
*ulcers with delayed healing
*lifestyle-limiting claudication
note - these are the indications for surgery
peripheral artery disease (PAD) - natural history of intermittent claudication
*exertion-related muscular pain that is relieved by rest
*very LOW RISK of limb loss
*majority remain with stable symptoms over time (ex. walking distances decrease over time)
peripheral artery disease (PAD) - progression to critical limb ischemia
*major predictors for progression include:
-ABI (Ankle Brachial Index < 0.90) at presentation
-diabetes
-continued smoking
*critical limb ischemia has a dismal prognosis (loss of limb or mortality at 6 months common)
peripheral artery disease (PAD) - physical exam findings
*decreased or absent pulses
*thickening of toe nails
*loss of hair in a stocking distribution
*cool feet
*dependent rubor (skin discoloration)
*delayed capillary refill
*healed or current foot and toe ulcers
peripheral artery disease (PAD) - findings that suggest we should obtain an ankle-brachial index (ABI)
*exertion-related lower extremity symptoms
*non-healing wounds of the lower extremities
*age > 65
*age > 50 with history of tobacco use or diabetes
peripheral artery disease (PAD) - MEDICAL TREATMENT
*smoking cessation
*lipid lowering therapy (STATINS)
*diabetes management
*hypertension management
*antiplatelet therapy (aspirin, clopidogrel)
*exercise therapy
*pharmacologic therapy for claudication
acute limb ischemia - causes
*an arterial occlusive disease
*commonly caused by:
-thrombosis (consequence of atherosclerotic disease)
-trauma (posterior knee dislocation, tibial plateau fracture, supracondylar humerus fracture, projectile injuries)
-embolism (spontaneous arterial embolus from the heart, usually due to AFib, MI, etc)
-low flow/hypoperfusion
acute limb ischemia - treatment
*immediate heparinization and vascular surgery (restoration of blood flow)
*fasciotomy to prevent re-vascularization injuries
peripheral artery disease (PAD) - wound types
- venous insufficiency wounds
- arterial insufficiency wounds
- neuropathic wounds
- mixed wounds
peripheral artery disease - venous insufficiency wounds
*usually ulcerations
*located around the malleoli of the ankles (“Gaiter” distribution)
*usually not painful
*treatment based upon resolving venous HTN:
-COMPRESSION
-multilayer dressing
-ablation of incompetent veins
