PVD and PAD

Question 1

Peripheral Vascular Disease & Peripheral Arterial Disease

Answer 1

Both are progressive diseases that narrow or block blood vessels, however, there are differences

Question 2

Peripheral Vascular Disease (PVD)

Answer 2

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

Question 3

Peripheral Arterial Disease (PAD)
What is it?
Chronic or Sudden?

Answer 3

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

Question 4

What causes most arterial vascular disease?

Answer 4

Atherosclerosis
- PAD is a marker of advanced atherosclerosis

Question 5

Symptoms of PAD and when do they present?

Answer 5

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

Question 6

Physical Assessment Findings in PAD

Answer 6

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

Question 7

PVD Symptoms

Answer 7

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

Question 8

Diagnosis of PVD or PAD

Answer 8

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

Question 9

Ankle-Brachial Index (ABI) in normal person

Answer 9

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)

Question 10

Ankle-Brachial Index in people with PVD

Answer 10

• ABI decreases (<1.0)
• Especially before & after exercise
• The lower the ABI the worse the PAD

Question 11

Calculation of ankle-brachial index (ABI)

Answer 11

ABI = the highest systolic ankle pressure (mmHg)/highest systolic arm pressure (mmHg)

Question 12

Normal ABI

Answer 12

= > 1.0

Question 13

ABI for patients with claudication

Answer 13

0.5-0.9

Question 14

ABI for patients with rest pain & critical leg ischemia

Answer 14

= < 0.5

Question 15

Acute Arterial Ischemia (AAI)
- what is it?
- what causes it?

Answer 15

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

Question 16

Most frequent cause of AAI

Answer 16

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)

Question 17

Six Ps of acute arterial ischemia:

Answer 17

Pain
Pallor (blanching with leg elevation)
Paralysis (ischemia of motor nerves)
Pulselessness
Peresthesia (numbness or tingling)
Poikilthermia (cool to the touch)

Question 18

Management of Peripheral Artery Disease (5)

Answer 18

1. Risk Factor Modification
2. Drug therapy
3. Exercise
4. Nutritional Therapy
5. Complementary & alternative therapy

Question 19

Management of Peripheral Artery Disease: Risk Factor Modification

Answer 19

Diabetes
Smoking
Cholesterol
HTN

Question 20

Management of Peripheral Artery Disease: Drug Therapy

Answer 20

Antiplatelet agents: ASA
ASA + Plavix together NOT recommended generally. sometimes in high-risk patients
Pentoxifylline (trental) - for intermittent claudication

Question 21

Management of Peripheral Artery Disease: Exercise

Answer 21

Cessation of smoking combined with supervised exercise

Question 22

Management of Peripheral Artery Disease: Nutritional therapy

Answer 22

to decrease BMI

Question 23

Management of Peripheral Artery Disease: Complementary & alternative therapy

Answer 23

Vitamin, mineral, herb supplements -> but current research data insufficient

Question 24

Critical Limb ischemia

Answer 24

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

Question 25

Endovascular Procedure: Interventional Radiological Catheter-Based for PVD (4)

Answer 25

1. Percutaneous Transluminal Angioplasty (PTA)
2. Stents
3. Atherectomy
4. Cryoplasty

Question 26

Percutaneous Transluminal Angioplasty (PTA)

Answer 26

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

Question 27

Stents

Answer 27

• Deployment of expandable metallic devices within the artery immediately after PTA
• To treat peripheral artery dissection (tear inner arterial wall)

Question 28

Atherectomy

Answer 28

• removal of obstructing plaque with a high-speed cutting disc built into catheter end

Question 29

Cryoplasty

Answer 29

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