peripheral vascular disease Flashcards
you deplete your peripheral vascular system of oxygen and blood and you will have
pain
Chronic PVD
•Is a progressive narrowing and degeneration of arteries of the neck, abdomen, & extremities.
what is responsible for most peripheral vascular disease
atherosclerosis
usually what age is PAD
65 and older but earlier with diabetes
what ethnicity has a great risk for pAD
african americans
gender differences with PAD
in 60’s men are 2Xs more likely to have PAD than women
abdominal aortic aneurysms more common in men
Buerger’s ( Thromboangitis Obliterans)
•predominantly seen in men less than 40 yrs.
Women and PAD
- As women age, incidence of PAD is similar or greater than men. Have more decreased functioning, more bodily pain, & greater mood disturbances than men with PAD.
- Women have smaller arteries so endovascular repair in AAA may not be an option.
- Raynaud’s phenomena is primarily seen in women 15-40 yrs.
who is at risk of DVT’s
•greater in women over 35 yrs who smoke, use oral contraceptives or HRT, are pregnant or post-partal or have a family history of DVTs.
risk for varicose veins is greater
•women who use oral contraceptives or Hormone Replacement Therapy or are pregnant.
4 most significant risk fctors for PAD
- Cigarette smoking
- Hyperlipidemia
- Hypertension
- Diabetes
Also obesity and familial predisposition play a part
Chronic PAD of the extremeties
- Can affect aortoiliac, femoral, popliteal, tibial and peroneal arteries or any combination.
- Femoral-popliteal area most commonly affected in non-diabetics. Diabetics develop disease in arteries below the knees.
- In advance stages, multiple levels of occlusions can be found.
stages of chronic PAD
asymptomatic
claudication
rest pain
necrosis/gangrene
asymptomatic PAD
- No claudication present
- Bruit or aneurysm may be present
- Pedal pulses are decreased or absent
claudication PAD
Muscle pain, cramping, or burning with
exercise and relieved with rest. Symptoms are reproducible with exercise.
rest pain PAD
Pain while resting commonly awakens the
patient at night. Is described as numbness, burning, toothache-like pain. - Usually occurs in distal portion of extremity ( toes, arch, forefoot, or heel ), rarely in the calf or the ankle. Relieved by dependent position.
necrosis/gangrene
Ulcers and blackened tissue occur on toes,
the forefoot, and the heel. - Distinctive gangrene odor is present
inflow obstructions (PVD)
•involve distal end of the aorta and the common, internal and external iliac arteries. They are located above the inguinal ligament.
outflow obstructions (PVD)
•involve the femoral, popliteal, and tibial arteries. They are located below the superficial femoral artery.
symptoms of PVD
•Classic symptom is intermittent claudication which is ischemic muscle pain that is precipitated by a consistent level of exercise. It resolves within 10 minutes of rest or less and is reproducible.
a. Caused by end products of anerobic
metabolism.
b. Once stop exercise, metabolites clear
and pain stops.
. Disease of femoral or popliteal arteries
causes claudication in calf, ankle, &
toes. Below popliteal, claudication in
instep or foot. OUTFLOW
d. Disease of aortoiliac causes claudication
of lower back, buttocks, & thighs.
INFLOW
outflow symptoms (PVD)
Disease of femoral or popliteal arteries
causes claudication in calf, ankle, &
toes. Below popliteal, claudication in
instep or foot.
inflow symptoms (PVD)
Disease of aortoiliac causes claudication
of lower back, buttocks, & thighs.
INFLOW
paresthesia (PVD)
•toes & feet may result from nerve tissue ischemia. Common in Diabetes. Neuropathy can also cause excruciating pain. Diminishing perfusion to neurons produces loss of both pressure and deep pain sensation. Injuries can go unnoticed.
appearance of limb (PVD)
-Skin thin, shiny, & taut. Loss of hair on
lower legs. Decreased or absent pulses.
- Dry, scaly, dusky, pale or mottled skin.
Pallor may occur when extremity is elevated. Reactive hyperemia ( Rubor ) may occur when extremity is independent position. - Capillary refill greater than 3 seconds
- Ankle-Brachial index less than 0.70
- Edema absent unless limb constantly dependent.
