Peripheral Vascular Diseases

Question 1

What is occlusive peripheral arterial disease (PAD)? What conditions is this typically associated with? (2)

Answer 1

Chronic, occlusive arterial disease of medium and large sized vessels, the result of peripheral atherosclerosis.

Associated the hypertension and hyperlipidemia

Question 2

What is the primary results of peripheral vascular disease?

Answer 2

Diminished blood supply to affected extremities with pulses decreased or absent.

Question 3

What happens to the color of the extremities in elevated versus dependent positions in patients with peripheral vascular disease (PAD)?

Answer 3

Elevated = pale
Dependent = Dusky red

Question 4

What does a patient in the early stages of peripheral vascular disease exhibit?

Answer 4

Intermittent claudication
Pain described as burning, aching, and cramping
Occurs regularly and predictably with walking and is alleviated by rest.

Question 5

List 3 symptoms of late stage peripheral vascular disease.

Answer 5

1. Pain at rest
2. Muscle atrophy
3. Trophic changes (hair loss, skin and nail changes)

Question 6

List 3 symptoms exhibited by patients with critical stenosis PAD.

Answer 6

1. Resting or nocturnal pain
2. Skin ulcers
3. Gangrene

Question 7

What is thromboangiitis obliterans (Buerger’s disease)? Who does it typically affect?

Answer 7

1. Chronic, inflammatory vascular occlusive disease of small arteries and veins
2. Beings distally and progresses proximally in both UEs and LEs
3. Occurs commonly in young adults, largely males, who smoke

Question 8

List 6 signs and symptoms associated with thromboangiitis obliterans (Buerger’s disease).

Answer 8

1. Pain or paresthesia
2. Cyanotic cold extremity
3. Diminished temperature sensation
4. Fatigue
5. Risk for ulceration
6. Gangrene

Question 9

What is diabetic angiopathy? What is a major complication of this condition?

Answer 9

Inappropriate elevation of blood glucose levels and accelerated atherosclerosis

Neuropathy is a major complication

Question 10

What is Raynaud’s disease? Symptoms? Who does it typically affect?

Answer 10

1. Episodic spasm of small arteries and arterioles
2. Abnormal vasoconstrictor reflex exacerbated by exposure to cold or emotional stress; tips of fingers develop pallor, cyanosis, numbness and tingling
3. Affects largely females

Question 11

What are varicose veins?

Answer 11

Distended, swollen superficial veins

Question 12

What is a venous thromboembolism?

Answer 12

The formation of a blood clot in a deep vein that can lead to complications including DVT, pulmonary embolism, or post thrombotic syndrome.

Question 13

What is deep vein thrombophlebitis (DVT)?

Answer 13

Clot formation and acute inflammation in a deep vein

1. Progressive inflammation with tenderness to palpation
2. Dull ache, tightness or pain in calf
3. Swelling, warmth, redness or discoloration in the LE

Question 14

What standardized risk assessment measure should be used to assess for DVTs?

Answer 14

Wells Criteria score for DVT

Question 15

How are DVTs typically treated? (2)

Answer 15

1. Anticoagulation therapy (low molecular weight heparin)

2. Graded compression stockings

Question 16

Low molecular weight heparin is contraindicated in patients with _____.

Answer 16

High risk for bleeding

Question 17

List 5 signs of a pulmonary embolism.

Answer 17

1. Abrupt chest pain
2. Abrupt dyspnea
3. Diaphoresis
4. Cough
5. Apprehension

Question 18

What is chronic post thrombotic syndrome? List 5 signs and symptoms associated with this condition.

Answer 18

Combination of clinical signs and symptoms that persist after a LE DVT

1. Pain
2. Intractable edema
3. Limb heaviness
4. Skin pigmentation changes
5. Leg ulcers

Question 19

What is chronic venous stasis/incompetence?

Answer 19

Venous valvular insufficiency from fibroelastic degeneration of valve tissue, venous dilation.

Question 20

Describe the 3 classification of chronic venous stasis/incompetence.

Answer 20

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

Question 21

What type of positioning should be encouraged in patients with chronic venous sufficiency?

Answer 21

Extremity elevation, minimum of 18 cm above heart.

Encourage patients to elevate leg as much as possible and avoid the dependent position

Question 22

List 5 contraindications to compression therapy.

Answer 22

1. ABI < 0.8 in the involved extremity
2. signs of active infection or cellulitis
3. Systemic arterial pressure < 80 mmHg
4. Advanced peripheral neuropathy
5. Uncontrolled CHF

Question 23

What exercises are the most effective for increasing blood flow in patients with peripheral arterial disease?

Answer 23

Resistive calf exercises