Peripheral Vascular Disease Flashcards
PVD =
Presence of systemic atherosclerosis in arteries distal to the aortic arch
Risk Factors
Smoking Male DM HTN/Ischemic heart dz Hyperlipidemia >60 yo
Symptoms
Intermittent claudication Asymptomatic (90%) Non-healing ulcers on the leg Cold feet/legs Dependent rubor
PE
Absent or diminished pulses Abnormal skin color (dependent rubor) Poor hair growth Cool skin Femoral artery bruit
DD
Spinal stenosis Baker cyst Chronic compartment syndrome Foot arthritis Nerve root compression Restless leg syndrome Muscle/tendon strains Peripheral neuropathy
Labs
Dx Tests
CBC Fasting Glucose or Hg A1C Fasting Lipids Serum Creat UA
Ankle/Brachial Index
Drug Tx
Antiplatelet therapy
Aspirin
Clopidogrel (Plavix)
Ticlopidine (Ticlid)
Phosphodiesterase Inhibitors
Cilostazol (Pletal)
Pentoxifylline (Trental)
Exercise Stress Test
PVD is a marker for CAD
Need to obtain exercise stress test before allowing vigorous exercise
Exercise Management
Intermittent Walking Technique
Walk until moderate to near maximal Claudication pain.
Rest briefly at sever claudication symptoms.
Rest in sitting or standing position.
Restart walking when claudication symptoms are tolerable.
Exercise Management
Timed Walking
Start: 3-5 times a week for 30 minutes per time.
Increase by 5 minutes until 50 minute sessions are tolerated.
Continue program for at least 6 months.
S&S of Acute Limb Ischemia
5 P’s
Pain Pulselessness Pallor Parasthesia Paralysis
Surgical Intervention Indications
Failed maximal medical therapy Severe symptoms significantly reducing life quality. Limb threatening ischemia Rest pain Non-healing wounds Gangrene
Surgical Procedures
Angioplasty (with or without stent placement)
Arterial Bypass
Intra-arterial Directed Thrombolysis
Recommendations
Exercise increases walking time in pts with claudication
ASA reduces risk of serious vascular events
Most reliable physical findings: absent pedal pulse, femoral artery bruit, abnormal skin color, cool skin temp
Pts w/PVD and high chol should be tx’d with diet modifications and lipid lowering agents as needed
Pursue aggressive BP reduction
Duplex ultrasonography, MRA, and angiography are indicated for determining lesion localization and are best used when invasive intervention is a possibility