Peripheral Vascular Disease (2) Flashcards
What is peripheral vascular disease?
Slow and progressive circulation disorder caused by narrowing, blockage, or spasms in a blood vessel
Where is PVD involved?
In any blood vessels outside of the heart (arteries and veins)
What is peripheral arterial disease caused from?
Structural changes in the vessel wall
Narrowing of vascular lumen
Spasm of vascular SMC
What can structural changes in the vessel wall in peripheral arterial disease be due to?
Degeneration secondary to inflammation or infection and lead to dilation, aneurysms, dissection, or rupture
What is a common symptom in peripheral arterial disease?
Intermittent claudication
Pallor on elevation
Why does pallor on elevation occur in peripheral arterial disease?
Insufficient arterial pressure to perfuse when leg is elevated above the heart
What test is used for intermittent claudication?
Walking test
How is the walking test performed?
Have a patient walk at cadence to keep intensity consistent until they notice symptoms then have them rest and resume when symptoms go away (compare times)
How does claudication pain occur if intensity is kept consistent?
At predictable and reproducible durations
What are findings in peripheral arterial disease?
Blood pooling in maximally dilated capillary bed (dependent rubor)
Impaired capillary refill
Impaired peripheral pulses
What may happen to the limbs in peripheral arterial disease?
May show signs of cyanosis
May feel cool to the touch
Is there numbness and tingling in affected area with peripheral arterial disease?
Yes
How does the skin appear in peripheral arterial disease?
Shiny, thin, pale, and hairless
What happens to the nails in peripheral arterial disease?
They become thick and brittle
How do you do the ankle brachial index?
Patient is in supine and use posterior Tibialis and Dorsalis pedis arteries
What is the cutoff in the ankle brachial index for PAD?
<0.9
What does an ankle brachial index of 0.5-0.8 indicate?
Claudication
What does an ankle brachial index of <0.5 indicate?
Critical ischemia
What are individuals with PAD at a high risk for?
AAA
What do patients with intermittent claudication tend to have?
Walking impairment that improves significantly with exercise training
What has exercise training been show to be as effective as in intermittent claudication?
Surgical interventions
Why should patients with PAD be instructed on proper foot wear, foot care, and hygiene?
Possible foot ulcer
How can you improve pain while sleeping with PAD?
Elevate head of bed
What is most effective for exercise training in claudication?
Interval training with short rest periods for relief of claudication
How should exercise be conducted in patients with PAD?
3x a week
Intensity should cause claudication pain in 3-5 min and continue until pain of 5/10 and then rest
Repeat this for 30 minutes
What is Raynaud’s syndrome?
Vasospasm causing reduced blood flow
What is primary Raynaud’s syndrome?
More common in women lasting 15-30 seconds often in cold climates
What is secondary Raynaud’s syndrome?
Less common but more serious usually around age 40 (due to repetitive trauma, smoking, or atherosclerosis)
What is severe Raynaud’s syndrome?
Rare but could result in permanent hypoperfusion of digits
What is an aneurysm?
Localized abnormal dilation by at least 50%
What are causes of aneurysms?
Atherosclerosis or congenital defects
What are risk factors for aneurysms?
CVD (smoking)
Male
Genetics
40-60 y/o
Hypertension
What are the types of aneurysms?
Saccular (berry)
Fusiform
Dissecting
What is a secular (berry) aneurysm?
Small and spherical (most common in brain tissue)
What is a fusiform aneurysm?
Gradual and more progressive
What is a dissecting aneurysm?
Blood filled channel within vessel wall
Where does pain occur with an AAA?
Low back, groin, mid abdominal left flank, or chest
What is an AAA?
Palpable pulsating abdominal mass > 3 cm
What is an independent predictor of AAA?
Inter arm systolic BP difference > 20 mmHg
What is chronic venous insufficiency?
Vein wall or valves in the leg veins do not work effectively which impairs the ability for blood to return to the heart from the legs (results in venous stasis)
What 3 systems is the venous network for chronic venous insufficiency divided into?
Superficial
Deep
Perforating or communicating veins
What makes up the superficial venous system?
Lesser and greater saphenous
What makes up the deep venous system?
Anterior and posterior Tibial
Peroneal
Popliteal
Deep and superficial femoral
Iliac veins
What may cause chronic venous insufficiency?
Vein wall degeneration, post thrombotic valvular damage, chronic venous obstruction, or dysfunction of muscular pumps
What is edema?
Apparent increase interstitial fluid volume
When does edema develop?
When starling forces are altered so there is increased flow of fluid from vascular system into interstitium
What is generalized edema?
Heart failure, hypo-albumenia, nephrotic syndrome, cirrhosis, and sepsis
What is localized edema?
MSK injury or DVT
What is a 1+ for pitting edema?
Barely detectable impression when finger is pressed into skin
What is a 2+ for pitting edema?
15 seconds to rebound
What is a 3+ for pitting edema?
30 seconds to rebound
What is a 4+ for pitting edema?
> 30 seconds to rebound
What are some things PTs can do to help with chronic venous insufficiency?
Exercise to increase muscle pump
Short walks
Pressure stockings or pump
Unna boot
What is an ulcer?
Persistent discontinuity in integrity of skin despite given time to heal
What are the 3 types of ulcers?
Venous
Arterial
Neuropathic
What is a venous ulcer?
Usually medial
Browning
Varicose veins and pitting edema
What is an arterial ulcer?
Distal to toes
Painful
Pallor, loss of hair, nail dystrophy
What is a neuropathic ulcer?
Plantar (usually due to pressure points)
What does a patient with a venous ulcer usually have?
Chronic venous insufficiency
What does a patient with an arterial ulcer have?
Peripheral artery disease
What does a patient with a neuropathic ulcer have?
Diabetic neuropathy
