peripheral vascular disease Flashcards
PVD
umbrella term used to describe several circulatory diseases
only called PAD when arteries are involved
pathophysiology of PVD
related to atherosclerosis processes in the extremities
lower ext. atherosclerosis
ischemia reperfusion of calf skeletal muscle
reduced myofibers in calf muscle, impaired mitochondria, muscle damage, impaired peripheral nerve function
impaired oxygenation
reduced leg strength
poor 6 min walk
increased rates of mobility loss
risk factors for PVD
smoking, high cholesterol, stroke, diabetes, heart disease, increased age >50
causes of PVD
atherosclerosis- most common cause
thrombus
inflammation- thromboangitis
vasospasm- Raynaud’s disease or an autoimmune disease
clinical manifestations of PVD
dull achy pain in legs lower leg edema pulse present drainage sores with irregular borders yellow slough or ruddy skin thick toenails sore on ankles tired/heavy legs pain WORSENS when standing and IMPROVES with elevation and activity
what is intermittent claudication?
cramping pain of lower extremity or buttock caused by atrial flow obstruction
STOPS WITH REST
caused by ischemic tissue
pain depends on site of plaque build up, collateral circulation
common site for PAD
femoral artery
causes of PAD
lack of circulation pain decreased pulse coolness of leg pallor of leg loss of sensation in foot ischemia of muscle in lower leg, cellular hypoxia
5 p’s of PVD
pain (intermittent caludication) pulselessness palpable coolness parasthesias paresis (weakness of extremity)
how do you diagnose PVD
ankle-brachial index
ankle-brachial index (ABI)
comparison of blood pressure in leg vs. arm
normal ratio is greater than 1
normal= ankle pressure is greater than brachial pressure
a ABI of 1-1.4
normal
a ABI of 0.9-1.0
acceptable
a ABI of 0.8-0.9
some arterial disease
treat risk factors
a ABI of 0.5-0.8
moderate arterial disease, refer to vascular specialist
ABI less than 0.5
severe arterial disease, refer to vascular specialist
clinical manifestations of PAD
intermittent claudication pain no edema no pulse or weak pulse no drainage round smooth sores black eschar sores on toes and feet cramping pain, tired leg and hip muscles that WORSENS with activity and subsides with rest
treatment of PAD
antiplatelet (clopidogrel)
surgical: fempop bypass
what causes PAD
narrowing or arteries, commonly in pelvis and legs
what is chronic venous insufficiency? (CVI)
occurs when venous walls and/or valves in leg VEINS are not working effectively
causes blood to pool or collect in the veins (venous stasis)
chronic
symptoms of venous insufficiency
lower extremity edema achiness or tiredness in legs leathery looking skin stasis ulcers flaking or itching skin new varicose veins
nonpharmacological treatment of PVD
reduction of contributing factors smoking cessation increase physical activity weight reduction stress reduction DM management HTN control
pharmacological tx of PVD
antiplatelet agents
anticoags
thrombolytics
lipid lowering agents
cilostazol (pletal)
used for intermittent claudication
platelet inhibitor, vasodilation
side effects of cilostazol
ha, dizziness, diarrhea, abnormal stools, palpitations, peripheral edema
drug interactions with cilostazol
metabolized by cytochrome P450
pentoxifylline/trental
vasoactive agent
used to treat intermittent claudication caused by PVD
relieves leg pain by increasing blood flow and oxygen through blood vessels.
help increase walking distance an duration
PO TID
adverse reactions of pentoxifylline/trental
n/v, dizziness
