PVD and PAD Flashcards
Peripheral Vascular Disease & Peripheral Arterial Disease
Both are progressive diseases that narrow or block blood vessels, however, there are differences
Peripheral Vascular Disease (PVD)
PVD is a broader term that includes any blood vessel encompassing arteries, veins and lymphatic vessels
PVD doesn’t cause structural damage of the vessel
Peripheral Arterial Disease (PAD)
What is it?
Chronic or Sudden?
Affects arteries alone and damages tissues of vessel walls
Tissue damage is caused by accumulation of fat
Condition in which thickening of artery walls leads to progressive narrowing of arteries of the upper and lower extremities
Can occur suddenly, following an embolus, or thrombus, or insidiously as in atherosclerosis
What causes most arterial vascular disease?
Atherosclerosis
- PAD is a marker of advanced atherosclerosis
Symptoms of PAD and when do they present?
When symptomatic -> intermittent claudication (exertional related) - classic symptom. with progression of disease, symptoms may occur at rest, often in toes, and worse at night) it is lower extremity muscle pain that occurs during exercise
- clinical symptoms occur when vessels are 60-70% occluded
Physical Assessment Findings in PAD
Smooth, shiny hairless skin in lower extremities; decreased or delayed distal pulses
Pain or cramping in legs (muscles calf, thigh, or buttocks) during activity and disappears at rest
Numbness and tingling
Slow healing or non-healing sores on toes, feet, or legs
Skin color changes
Poor nail growth
Thinning of skin on legs
Some people do not experience ANY symptoms
PVD Symptoms
Dull cramping and pain that comes and goes in the legs
Heaviness or tightness in the leg muscles
Leg or foot that feels cool or cold to the touch compared to the other leg
Burning sensation
Leg fatigue, leg or foot feeling cool or cold to the touch
Skin colour changes
Loss of leg hair
Diagnosis of PVD or PAD
For assessing blood flow & outline the vascular system
- health hx & physical exam (peripheral pulses)
- angiography (dye visible by x-ray)
- ankle-brachial index (ABI)
- doppler ultrasound studies
Ankle-Brachial Index (ABI) in normal person
ABI is a peripheral artery disease screening tool
In a normal person:
- SBP in legs is slightly higher than in arms (ankle-brachial index >1.0)
Ankle-Brachial Index in people with PVD
- ABI decreases (<1.0)
- Especially before & after exercise
- The lower the ABI the worse the PAD
Calculation of ankle-brachial index (ABI)
ABI = the highest systolic ankle pressure (mmHg)/highest systolic arm pressure (mmHg)
Normal ABI
= > 1.0
ABI for patients with claudication
0.5-0.9
ABI for patients with rest pain & critical leg ischemia
= < 0.5
Acute Arterial Ischemia (AAI)
- what is it?
- what causes it?
Sudden interruption of blood flow to tissue, organ, or extremity that, if left untreated, would result in tissue death
Caused by embolism, thrombosis of pre-existing atherosclerotic artery, or trauma
Most frequent cause of AAI
A thrombus from heart is most frequent cause of acute arterial occlusion
Thrombi that originate in the left side of the heart - majority obstruct an artery of lower extremities (iliofemoral, popliteal, tibial)
Six Ps of acute arterial ischemia:
Pain
Pallor (blanching with leg elevation)
Paralysis (ischemia of motor nerves)
Pulselessness
Peresthesia (numbness or tingling)
Poikilthermia (cool to the touch)
Management of Peripheral Artery Disease (5)
- Risk Factor Modification
- Drug therapy
- Exercise
- Nutritional Therapy
- Complementary & alternative therapy
Management of Peripheral Artery Disease: Risk Factor Modification
Diabetes
Smoking
Cholesterol
HTN
Management of Peripheral Artery Disease: Drug Therapy
Antiplatelet agents: ASA
ASA + Plavix together NOT recommended generally. sometimes in high-risk patients
Pentoxifylline (trental) - for intermittent claudication
Management of Peripheral Artery Disease: Exercise
Cessation of smoking combined with supervised exercise
Management of Peripheral Artery Disease: Nutritional therapy
to decrease BMI
Management of Peripheral Artery Disease: Complementary & alternative therapy
Vitamin, mineral, herb supplements -> but current research data insufficient
Critical Limb ischemia
characterized by chronic ischemic rest pain lasting > 2 weeks, arterial leg ulcers, or gangrene of the leg as a result of PAD
Optimal Therapy
1. endovascular procedure
2. surgery: revascularization & to decrease CVD event
Endovascular Procedure: Interventional Radiological Catheter-Based for PVD (4)
- Percutaneous Transluminal Angioplasty (PTA)
- Stents
- Atherectomy
- Cryoplasty
Percutaneous Transluminal Angioplasty (PTA)
to restore blood flow with the use of a balloon-mounted catheter, the tip is advanced to where the stenosis is and inflated
An established treatment for peripheral arterial occlusion. For short stenosis or occlusion of iliac, femoral and popliteal arteries
Stents
- Deployment of expandable metallic devices within the artery immediately after PTA
- To treat peripheral artery dissection (tear inner arterial wall)
Atherectomy
- removal of obstructing plaque with a high-speed cutting disc built into catheter end
Cryoplasty
2 procedures: balloon angioplasty + cold therapy
the specialized balloon inflated with nitrous oxide that changes from liquid to gas as it enters the ballon & decrease temp of gas to -10C. The cold temp minimizes restenosis
