Peripheral Vascular Disease

Question 1

Peripheral Vascular Disease (PVD)

Answer 1

-umbrella term describing several circulatory diseases
-includes peripheral venous disease, peripheral arterial disease
-ONLY called peripheral arterial disease (PAD) when ONLY the arteries are affected

Question 2

PVD: Patho

Answer 2

related to atherosclerosis processes in the extremities
lower extremity atherosclerosis–> ischemia reperfusion of muscles–> reduced myofibers in muscles/impaired mitochondrial function/muscle damage and degeneration/impaired peripheral nerve function—-> impaired O2 consumption/reduced strength–> increased rates of mobility loss

Question 3

PVD: Risk Factors (6)

Answer 3

SMOKING
diabetes
high cholesterol
heart disease
stroke
increased age >50

Question 4

PVD: Etiology (4)

Answer 4

-atherosclerosis- MOST common cause
-a thrombus
-inflammation:
-thromboangitis
obliterans which is an
inflammatory condition
of the arteries
-vasospasm:
-Raynaud’s disease or
phenomenon an
autoimmune disease

Question 5

Clinical Manifestations

Answer 5

d/t local tissue ischemia and appear in the extremities
-pain: calf pain, “buttock pain”
-numbness/burning
-heaviness
-intermittent
claudication
-wounds that don’t heal
-diminished sensation in extremities
-trophic skin changes
-skin: shiny, thick
toenails
-loss of leg hair
-diminished pulses
-elevation pallor,
cyanosis
-reactive hyperemia
(dependent rubor)
-erectile dysfunction

Question 6

Intermittent Claudication

Answer 6

Caused by ARTERIAL flow obstruction
consistent pain precipitated by consistent level of exercise
CEASES WITH REST
caused by ischemic tissue

pain depends on
-site of plaque build up
-collateral circulation

Question 7

What is “angina” of the lower extremities?

Answer 7

intermittent claudication

Question 8

What is the common site for PAD?

Answer 8

femoral artery

Question 9

PAD: Femoral Artery

Answer 9

-atherosclerosis of femoral artery
-lack of circulation
-pain (intermittent
claudication)
-decreased pulse
-coolness of leg
-pallor of leg
-loss of sensation in foot
-ischemia of muscle in lower leg, CELLULAR HYPOXIA

Question 10

The 5 Ps of PAD

Answer 10

1. Pain (intermittent claudication)
2. Pulselessness
3. Palpable coolness
4. Paresthesias
5. Paresis (weakness of extremity)

Question 11

PVD: Diagnosis

Answer 11

ankle-brachial index

-comparison of the blood pressure in the leg vs. the arm
-normal ratio is greater than 1
-normal: ankle pressure is greater than brachial pressure
-SEVERE PAD ankle-brachial index (ABI)= 0.5

Question 12

PVD: Arterial Ulcers: CM

Answer 12

intermittent claudication pain
no edema
no pulse or weak pulse
no drainage
round, smooth sores
black eschar
location of sores: toes and feet

Question 13

PVD: Venous Ulcers: CM

Answer 13

dull, achy pain
lower leg edema
pulse present
drainage
sores with irregular borders
yellow slough or ruddy skin
location of sores: ankles

Question 14

Chronic Venous Insufficiency

Answer 14

a condition that occurs when the VENOUS wall and/or VALVES in the leg veins are not working effectively
CVI causes blood to “pool” or collect in these veins= venous stasis

affects about 40% of US population

Question 15

Venous Insufficiency: Symptoms (6)

Answer 15

lower extremity edema
achiness or tiredness in legs
leathery looking skin
stasis ulcers
flaking or itching skin
new varicose veins

Question 16

PVD: NONpharmacological Treatment

Answer 16

reduction of contribution factors
-SMOKING CESSATION
-increase physical activity
-weight reduction
-stress reduction
-diabetes management
-HTN control

Question 17

PVD: Pharamacological Treatment

Answer 17

antiplatelet agents
anticoags
thrombolytics
lipid lowering agents
antihypertensives
agents that increase blood supply to the extremities