Peripheral Vascular Disease (PAD)

Question 1

name three components of the pathophysiology of PAD

Answer 1

atherosclerosis, vasospasm, inflammation

Question 2

H&P for PAD

Answer 2

diabetes, smoking, hypertension, obesity, exercise intolerance, loss of hair on legs and feet, diminished peripheral pulses

Question 3

sx/sx of PAD

Answer 3

thin, shiny, taut skin
loss of hair on feet and legs
diminished/stopped pulses (pedal, popliteal, femoral)
paraesthesia
pallor
“dependent rubor”

Question 4

what are two pains specific to PAD?

Answer 4

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)

Question 5

complications of PAD

Answer 5

atrophy of skin and underlying muscles
delayed healing, wound infection
necrosis
arterial ulcers (non-healing)
gangrene
amputation

Question 6

goals/outcomes

Answer 6

wanting:
adequate tissue perfusion
relief of pain
increased exercise tolerance
intact, healthy skin on extremities

Question 7

priorities in home care (PAD)

Answer 7

meticulous foot care (daily inspections)
tobacco of any form contraindicated
encourage physical activity
comfortable shoes (not tight or etc)

Question 8

diet and exercise

Answer 8

eat healthy, keep cholesterol below 200 mg/day, decrease intake of saturated fat, walking best exercise for individuals with intermittent claudication

Question 9

what do ACE inhibitors (Benazepril, Lisinopril, Ramipril, Enalapril, Captopril) do for someone with PAD?

Answer 9

decreases cardiovascular morbidity/mortality
increases peripheral blood flow, ABI, and walking distance

Question 10

drugs for intermittent claudication

Answer 10

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

Question 11

critical limb ischemia

Answer 11

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

Question 12

what are indications for Interventional Radiology (IR) procedures

Answer 12

indications are:
rest pain
incapacitating intermittent claudication
limb viability threatened

Question 13

Interventional Radiology procedures

Answer 13

Percutaneous transluminal balloon angioplasty (PTA)
Stents
Atherectomy

Question 14

surgical procedures

Answer 14

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

Question 15

highlights: post-op care

Answer 15

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

Question 16

post op care part two

Answer 16

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

Question 17

Thromboangitis Obliterans (Buerger’s Disease)

Answer 17

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

Question 18

tx: Buerger’s disease

Answer 18

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

Question 19

Raynaud’s phenomenon

Answer 19

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)

Question 20

How to remember the symptoms of Raynaud’s disease

Answer 20

onset of minutes to hours
COLORS: WHITE
decreased perfusion–pallor–white (coldness and numbness)
BLUE
cyanosis
RED
hyperemic response– throbbing, aching pain, swelling, tingling