Peripheral Vascular System Diseases and Assesments Flashcards
inflammation and occlusion affecting medium to large arteries
Atherosclerosis Obliterans
affectation of ASO
LE > UE
early warning sign of ASO
intermittent claudication
late sign of ASO
gangrene
pain distribution of vascular claudication
usually bilateral
pain distribution of neurogenic claudication
usually bilateral, may be unilateral
pain site in vascular claudication
calf
pain site in neurogenic claudication
back
buttocks
thigh
calves
feet
pain in vascular claudication presents
consistent in all spinal positions
pain in neurogenic claudication is aggravated by
spinal extension
walking
pain in neurogenic claudication is decreased by
spinal flexion
recumbency
pain in vascular claudication is relieved by
rest (1-5 mins)
distinguishing pain sensation in neurogenic claudication
burning and dysesthesia from back to buttocks and/or legs
pulses in vascular claudication
decreased or absent in LE
pulses in neurogenic claudication
normal
ages affected by vascular claudication
40 to 60+
ages affected by neurogenic claudication
40 to 60+
inflammation and occlusion of small arteries
Thromboangiitis Obliterans/Buerger’s dse
affectation of TAO
UE > LE
risk factors for TAO
young male
smoking
raynaud’s disease
primary Raynaud’s
Raynaud’s phenomenon
secondary Raynaud’s
onset for primary Raynaud’s
< 30 y/o
onset for secondary Raynaud’s
> 30 y/o
cause of primary Raynaud’s
idiopathic
cause of secondary Raynaud’s
secondary to another underlying medical condition
severity of primary Raynaud’s
mild S/Sx
severity of secondary Raynaud’s
severe S/Sx
risk factors for primary Raynaud’s
sex
age
climate
family hx
a substance risk factor for secondary Raynaud’s
vinyl chloride
distention or swelling of superficial veins due to dysfunctional valves
Varicose veins
S/Sx of varicose veins
aching, heavy leg c spider veins
common veins affected by Varicose veins
great Saphenous v.
small Saphenous v.
inflammation and clot formation affecting the superficial veins
Superficial vein thrombosis
complications for superficial vein thrombosis
varicosities
S/Sx of superficial vein thrombosis
pain along the course of saphenous veins
course of the great Saphenous vein
originates at the dorsal vein of the hallux
runs anteriorly to the medial malleolus
ascends to the medial aspect of the leg
runs to the posterior aspect of the medial epicondyle of the femur
passes over the medial aspect of the thigh
inflammation and clot formation affecting the deep veins
Deep Vein Thrombosis
what do you call the triad ofDVT?
Virchow’s triad
the Virchow’s triad includes
Hypercoagulability
Intimal wall damage
Venous stasis
what is venous stasis?
pooling of blood in the lower leg
why is Homan’s test contraindicated in DVT?
dislodges the clot
prevention for DVT
early mobilization
enlargement of lymph nodes with or without tenderness
lymphadenopathy
excessive fluid in the tissue in the lymph nodes
lymphedema
cause of secondary lymphedema
iatrogenic
primary lymphdema occurring after birth
Milroy’s dse
primary lymphedema present in people < 35 y/o
praecox
primary lymphedema present in people > 35 y/o
tarda
site of wound in venous insufficiency
proximal to the medial malleolus
site of wound in arterial insufficiency
lower 1/3 of the leg, toe, lateral malleolus
characteristics of venous insufficiency wounds
irregular, shallow appearance
characteristics of arterial insufficiency wounds
smooth edges
well-defined
tend to be deep
what happens when you elevate the leg of a patient c venous insufficiency?
pain decreases
what happens when you elevate the leg of a patient c arterial insufficiency?
pain increases
patients with arterial insufficiency present c
thin and shiny, hair loss, yellow nails
pts c venous insufficiency have a wound presentation of
flaking, brownish discoloration (hemosiderin staining)
pain severity in pts c venous insufficiency
mild to moderate
pain severity in pts c arterial insufficiency`
severe
BMI formula in metric units
kg/m^2
BMI formula in imperial
(lb/in^2)703
< 18.5 BMI
underweight
18.5 - 24.9 BMI
normal
25 - 29.9 BMI
overweight
30 - 34.9 BMI
obese class I
35 - 39.9 BMI
obese class II
40 or above BMI
obese class III
easily obliterated c slight pressure; fades in and out
grade 1+ pulse
easily obliterated c light pressure
grade 2+ pulse
requires moderate pressure to obliterate
grade 3+ pulse
not obliterated by moderate pressure
grade 4+ (bounding) pulse
positive sign for capillary refill time (CRT)
refill is longer than 2 secs
indication of CRT
impaired perfusion to the extremities
assessment for vascular intermittent claudication
treadmill test
how long does a treadmill test for vascular intermittent claudication last?
15 mins
how many trials does a treadmill for test vascular intermittent claudication have?
2 trials
what is the parameter for the 1st trial of treadmill test for vascular intermittent claudication?
1.2 mph
what is the parameter for the 2nd trial of treadmill test for vascular intermittent claudication?
preferred walking speed
assessments for neurogenic intermittent claudication
Bicycle test of Van Gelderen
Stoop test
(+) sign for bicycle test of Van Gelderen
the pt can cycle longer in a slumped position
(+) sign for stoop test
the pt continues walking in a slumped position
sites of ABI in LE
posterior tibial
dorsalis pedis
formula for R ABI
higher R ankle SBP (PT/DP) / higher arm SBP (L/R)
formula for L ABI
higher L ankle SBP (PT/DP) / higher arm SBP (L/R)
> 1.2 ABI possible indications
falsely elevated
arterial dse
diabetes
1.19 - 0.95 > 1.2 ABI possible indications
normal
0.94 - 0.75 ABI possible indication
mild arterial dse + intermittent claudication
0.74 - 0.50 ABI possible indications
mod arterial dse + resting pain
< 0.50 ABI possible indications
severe arterial dse
A non invasive test that examined the LE for the presence of ischemia.
Rubor of dependency
(+) sign for Rubor of Dependency
it takes > 30 secs for color to return to pink
indication of rubor of dependency
arterial insufficiency
Noninvasive test for arterial and venous circulation
Air plethysmography
what is observed in air plethysmography?
changes in leg volume during rest, standing, and light walking
what is obstructed in Allen’s test?
radial a.
ulnar a.
A non-invasive test that measures blood flow in the skin.
Skin perfusion pressure measurement
how is the venous filling time done?
pt in supine, leg is passively elevated to 45 deg for 1 minute then place in dependent position.
(+) sign Venous filling time
> 15 secs return
< 15 secs return
normal return time for venous filling time
15 secs
indication for Venous filling time
> 15 secs (arterial dse)
< 15 secs (venous dse)
how proximal is the greater saphenous vein to the knee when tapped in percussion test?
6 in (15.2 cm)
(+) sign for percussion test
a fluid is detected under the distal palpation site
another name for percussion test
Schwartz
indication of Schwartz’ test
valvular incompetency
how is Trendelenburg test done?
LE is elevated and a tourniquet is applied on the thigh. After one minute, the pt is asked to stand.
(+) sign for Trendelenburg test
vein distention within 5 secs after/before tourniquet being released
indication of Trendelenburg test
distention before 5 secs = valvular incompetence
distention after 5 secs = superficial vein incomptence
(+) sign for hand volume test
30-50 mL difference of water displacement between both hands
normal amount of difference in hand volume test
10 mL
(+) sign of Stemmer’s test
cannot pinch the skin at the 2nd MTT
indication of (+) Stemmer’s
lymphedema
2 mm depression; rebounds immediately
grade 1+ edema
4 mm depression; rebounds < 15 secs
grade 2+ edema
6 mm depression; rebounds 15-30 secs
grade 3+ edema
8mm depression: rebounds > 30 secs
grade 4+ edema
