Peripheral Vascular Disease (PAD) Flashcards
name three components of the pathophysiology of PAD
atherosclerosis, vasospasm, inflammation
H&P for PAD
diabetes, smoking, hypertension, obesity, exercise intolerance, loss of hair on legs and feet, diminished peripheral pulses
sx/sx of PAD
thin, shiny, taut skin
loss of hair on feet and legs
diminished/stopped pulses (pedal, popliteal, femoral)
paraesthesia
pallor
“dependent rubor”
what are two pains specific to PAD?
intermittent claudication (ischemic muscle ache pain, exercise can trigger, rest helps, but it’s reproducible)
rest pain (aggravated by limb elevation, occurs at night more, d/t insufficient blood flow, forefoot or toes are common places for it)
complications of PAD
atrophy of skin and underlying muscles
delayed healing, wound infection
necrosis
arterial ulcers (non-healing)
gangrene
amputation
goals/outcomes
wanting:
adequate tissue perfusion
relief of pain
increased exercise tolerance
intact, healthy skin on extremities
priorities in home care (PAD)
meticulous foot care (daily inspections)
tobacco of any form contraindicated
encourage physical activity
comfortable shoes (not tight or etc)
diet and exercise
eat healthy, keep cholesterol below 200 mg/day, decrease intake of saturated fat, walking best exercise for individuals with intermittent claudication
what do ACE inhibitors (Benazepril, Lisinopril, Ramipril, Enalapril, Captopril) do for someone with PAD?
decreases cardiovascular morbidity/mortality
increases peripheral blood flow, ABI, and walking distance
drugs for intermittent claudication
Pentoxifylline (Trental)
Decreases blood viscosity
Increases erythrocyte flexibility
Cilostazol (Pletal)
First line treatment for those who do not respond to exercise therapy
Increases vasodilation and walking distance
critical limb ischemia
chronic ischemic rest pain that continues for greater than two weeks. can lead to arterial leg ulcers and gangrene
interventions: protect form trauma, reduce vasospasm, prevent/control infection, maximize arterial perfusion, revascularization
what are indications for Interventional Radiology (IR) procedures
indications are:
rest pain
incapacitating intermittent claudication
limb viability threatened
Interventional Radiology procedures
Percutaneous transluminal balloon angioplasty (PTA)
Stents
Atherectomy
surgical procedures
Femoral Bypass Grafting
Synthetic grafts for long bypasses
USING: Human umbilical vein, Cryopreserved vein,
Composite sequential graft
Balloon angioplasty /stenting in combination with bypass
Endarterectomy
Patch graft angioplasty
Amputation
highlights: post-op care
Frequent monitoring: Check extremity every 15- min then every hour
Skin color & temperature
Capillary refill
Pulses distal to operative site
Sensation & movement of extremity
Continued circulatory assessment
Monitor for potential complications
Avoid knee-flexed positions
Except for exercise
Turn / position frequently
post op care part two
Discourage prolonged sitting & leg dependency
May cause pain, edema, increase risk of VTE & stress suture lines
If edema develops:
Position supine
Elevate edematous leg above heart level
Walking is desirable
Potential complications:
Bleeding
Hematoma
Thrombosis
Embolization
Compartment syndrome
Thromboangitis Obliterans (Buerger’s Disease)
Non-atherosclerotic, segmental, recurrent inflammatory disorder
Small / medium-sized arteries & veins
Upper / lower extremities
Young men (< 40 years)
Tobacco, but no other risk factors
High rate of periodontitis
tx: Buerger’s disease
Absolute tobacco cessation
Nicotine replacements contra-indicated
Antibiotics for infection
Analgesics
Avoid trauma to extremities
Surgery
Sympathectomy
Bypass
Selected patients with severe ischemia
Growing new blood vessels
Amputation
3% greater with continued tobacco use
Raynaud’s phenomenon
Episodic vaso-spastic disorder of small, cutaneous arteries
Fingers, toes, ears, nose
Young women
15 – 40 years
Etiology unknown
Exaggerated sympathetic response
Occupational trauma
Heavy metal exposure
Primary
Most common form
Lower physical & mental-health QOL
Secondary
Rheumatoid arthritis (RA)
Systemic lupus erythematosus (SLE)
How to remember the symptoms of Raynaud’s disease
onset of minutes to hours
COLORS: WHITE
decreased perfusion–pallor–white (coldness and numbness)
BLUE
cyanosis
RED
hyperemic response– throbbing, aching pain, swelling, tingling
