Peripheral Vascular Disease: Evaluation, Differential Diagnosis, Prognosis Flashcards
What is occlusive peripheral arterial disease (PAD)
Chronic, occlusive arterial disease of medium and large sized vessels, the result of peripheral atherosclerosis
What is PAD associated with
hypertension and hyperlipidemia
- pts may also have CAD, cerebrovascular disease, diabetes, metabolic syndrome, and a history of smoking
PAD affect on pulses
- diminished blood supply to affected extremities with pulses decreased or absent
PAD color
pale on elevation; dusky red on dependency
early stages of PAD
- patients exhibit intermittent claudication
- pain is described as burning, searing, aching, tightness, or cramping
- occurs regulars and predictably with walking and is relieved by rest
Later stages of PAD
- pts exhibit rest pain, muscle atrophy, trophic changes (hair loss, skin and nail changes)Cr
Occlusive stenosis PAD
- patients exhibit resting or nocturnal pain, skin ulcers, and gangrene
Which extremities does PAD mostly affect?
lower extremities
Diabetic angiopathy
- arterial disease
- an inappropriate elevation of blood glucose levels and accelerated atherosclerosis
- neuropathy is a major complication
- neurotrophic ulcers may lead to gangrene and amputation
Raynaud’s disease/Phenomenon
- episodic spasm of small arteries and arterioles
- abnormal vasoconstrictor reflex exacerbated by exposure to cold or emotional stress; tips of fingers develop pallor, cyanosis, numbness, and tingling
- affects largely females
- occlusive disease is not usually a factor
Varicose Veins
- distended, swollen superficial veins; tortuous in appearance
- may lead to varicose ulcers
Venous Thromboembolism (VTE)
- the formation of a blood clot in a deep vein that lead to complications including deep vein thrombosis (DVT), PE, or postthrombotic syndrome (PTS)
- can become chronic: post-thrombotic syndrome, leads to decreased quality of life
Mortality of VTE
- incidence of 10%-30% within 1 month of diagnosis
Morbidity of VTE
- 1/3 experiences another VTE within 10 years
Deep Vein Thrombophlebitis
- clot formation and acute inflammation in a deep vein
- usually occurs in LEs, associated with forced immobilization, surgery, trauma, and hyperactivity of blood coagulation or can be unprovoked
Sxs deep vein thrombophlebitis
- may be asymptomatic early; progressive inflammation with tenderness to palpation dull ache, tightness, or pain in the calf; swelling, warmth, redness, or discoloration in the LE; prominent superficial veins
Review wells criteria for DVT
p 264 of study guide
Medical management for DVT
- anticoagulation therapy is used to prevent new clots from forming, precent the existing clot from getting larger, and stabilize the clot through anti-inflammatory properties (LMWH)
- pts who are at high risk for bleeding are given unfractionated heparin (UFH)
- both LMWH and UFH are associated with heparin-induced thrombocytopenia
- graded compression stockings
what is HIT (heparin induced thrombocytopenia) associated with
a paradoxical increased risk for venous and arterial thrombosis
Homan’s Sign
AKA dorsiflexion sign
- may still be used in clinics but is has low associated sensitivity and specificity values and alone it is not diagnostic of DVT
Pulmonary embolism presentation
- presents abruptly with chest pain and dyspnea, also diaphoresis, cough, and apprehension; requires emergency treatment
PE mortality
- 20% with acute PE die almost immediately; 40% die within 3 months
what can PE result in
- chronic thromboembolic pulmonary hypertension with reduced oxygenation and pulmonary hypertension
- can lead to right heart dysfunction and failure
What is chronic post-thrombotic syndrome
- a combination of clinical signs and symptoms that persists after LE DVT
- thrombosis resolution is incomplete
Sxs of chronic post-thrombotic syndrome
- pain, intractable edema, limb heaviness, skin pigmentation changes, and leg ulcers
what does chronic post-thrombotic syndrome lead to
reduced quality of life and impaired functional mobility
chronic venous stasis/incompetence
- venous valvular insufficiency: from fibroelastic degeneration of valve tissue, venous dilation
chronic venous stasis/incompetence Classification
- Grade I: mild aching, minimal edema, dilated superficial veins
- Grade II: increased edema, multiple dilated veins, changes in skin pigmentation
- Grade III: venous claudication, severe edema, cutaneous ulceration
