PVD/PAD Flashcards
define pvd
Reduced blood flow to OR away from the limbs (Typically) due to narrowing of vessels
what causes PAD
atherosclerosis
PAD patho
- Result of atherosclerosis
- –>Partial or complete occlusion of artery in peripheral circulation
- –>Results in tissue death below area of occlusion
- –>Increased risk of MI and Stroke
PAD is increase risk for
MI/ stroke
PAD risk factors
- Hypertension
- Hyperlipidemia
- Diabetes mellitus
- Smoking
- Obesity
- Hypercholesterolemia
- Family history
- Advanced age
(all same risk factors as HTN + addition of HTN)
define 4 stages of PAD
I Asymptomatic-reduced pulses
II Claudication- pain when walking
III Rest pain- pain at rest
IV necrosis/ gangrene- ulcers
inflow vs outflow PAD
Inflow = Aorta, common, internal and external iliac arteries are effected
Outflow = Femoral, popliteal, tibial arteries are effected
s/s of PAD
- Pain > due to lack of O2
- Diminished pulses - lack of blood flow
- Pale - lack of blood flow
- Hair loss - lack of nutrients
- Dryness- lack of nutrients
- Scaling- lack of nutrients
- Ulcers - lack of O2
- Thickened toenails
- Dependent rubor- if someone has legs up then dangle the lower extremity will return red
- Muscle atrophy - lack of nutrients/blood
—> all of these are coming from lack of blood/O2/nutrients
Inflow disease symptoms:
Experience discomfort in the back, buttocks, or thighs
Outflow disease symptoms:
- Burning or cramping in the calves, ankles, feet and toes
- Obstruction below the popliteal associated with foot and instep pain
Diagnostics for PAD
- MRA
- CTA
- Segmental systolic blood pressure- take BPs down the leg
- **ABI
- Doppler
- Exercise tolerance testing
- plethysmography
what is an ABI
ankle brachial index
take BP of ankle and of brachial and should be similar ratio of 1 but if blood flow is decreased then we would have ABI of
PAD vs PVD - leg positions
PAD (^) - legs pointing down
PVD ( v)- legs up
should you exercise with PAD?
- Not for severe disease/ulcers -
- Exercise until pain. stop. start —> increase collateral circulation
heat or cold with PAD?
- head (avoid cold)
- No Heating pad due to loss of sensation- not aware that they are being burned
- use warm socks with arterial disease
FLuids with PAD?
increase fluids
drugs for pad
Antiplatelets Hemorheologic Phosphodiasterase inhibitors Antihypertensives Lipid Lowering medications
non surgical procedures for pad
- Percutaneous vascular intervention - stint to keep it open
- Atherectomy- remove the plaque
surgical intervention for PAD
bypass
- Autogenous (saphenous, cephalic, basilic veins) *preferred
- Synthetic grafts
-Do not remove plaque/artery - blood just takes path of least resistance
special line for PAD Bypass surgery?
arterial line to monitor BP
preoperative care: arterial bypass
- Infection prevention
- One or more IV lines or a central line
- Arterial line to monitor BP
- Urinary catheter- monitor output
How often to mark and assess pulses postop arterial bypass?
-Mark and assess pulses of affected extremity - every 15 min for an hour, every 30 for 4 hours, ever hour for 24 hours
reperfusion pain =
throbbing
2 PAD bypass surgery complications
graft occlusion
graft infection
signs of graft occlusion and how do we treat?
Severe aching continuous pain with graft occlusion (versus throbbing from normal reperfusion)
-Often treated with thrombectomy or Thrombolytic agent
What is an acute aterial occlusion?
- When an embolus travels and lodges in an artery
- On rarer occasion, caused by a local thrombus
- Usually travels from the heart due to A-fib (blood pooling in Atria and clots form) or MI
what are the 6 p’s of ischemia
Pain Pallor Pulselessness Parasthesia Paralysis poikilothermy- coolness
Acute arterial occlusions: Interventions
- Arteriotomy
- Catheter guided intra-arterial thrombolytic therapy
- done in IR , thread sheath in, guide wire/catheter is threaded in, put in TPA to break down clot
- can leave sheath in for a couple of days while clot is slowly broken down
3 types of Peripheral Venous disease
- Venous insufficiency
- Venous thromboembolism
- Varicose veins
who gets stasis ulcers? PAD or PVD
PVD
What is stasis dermatitis?
breakdown of iron –> discoloration blue/red/purplish + thickening of skin
Venous insufficiency assessment (3)
- Stasis dermatitis = breakdown of iron –> discoloration blue/red/purplish + thickening of skin
- Edema
- Stasis ulcers
Venous insufficiency: Interventions
- Prevent stasis and wound formation
- promote wound healing
- Prevent infection - cellulitis risk + ulcer infection
- Compression stockings/SCD
- Elevations of legs for 20 minutes, 4-5 times per day (for venous insufficiency) (V)
- Elevate legs above the level of the heart
- Use of pump devices
PAD vs PVD ulcers
Peripheral Arterial Disease (PAD)
- Painful
- Often develop on toes first
- Eventually become gangrenous
- Difficult to manage
- Round and small/ well defined
- Cool
- Absent arterial pulses
Vascular Insufficiency (Venous Ulcer)
- Often develop over inner ankle area
- Irregular borders
- Chronic and difficult healing, exudate
- warm
- pulses present or variable
Venous thromboembolism =
Where likely to occur
=Blood clot (thrombus or embolus) in the vein
-most likely to occur in deep veins in lower extremities but can occur in upper extremities
Deep vein thromboembolism =
=deep vein thrombophlebitis or DVT
What is the most important risk of a dvt?
PE
Who is at risk of developing DVT?
- Hip or knee surgery
- Open prostate surgery
- Ulcerative colitis
- Heart failure
- Cancer
- Oral contraceptives
- Immobility
- Phlebitis
- Most hospitalized people due to immobility and other conditions
Virchows Triad
determines risk of developing DVT
- Hypercoagulability of blood
- Vascular damage to the vessel
- Circulatory stasis
Dvt assessment
- Calf or groin tenderness
- Sudden onset of Pain and
- *Unilateral swelling of the leg
- Positive homan’s sign (unreliable) - dorsiflex foot and feel pain in calf
- Redness
- Warmth
DVT Diagnosis
- *Venous duplex ultrasonography - most helpful
- Doppler flow tests
- Impedance plethysmography
- MRI
- D-Dimer- looks at breakdown of firbinogen, all it tells us is that there is a clot somewhere
D Dimer looks at what and tells us what?
looks at breakdown of firbinogen, all it tells us is that there is a clot somewhere
Top 3 goals with DVT interventions
- *Preventing complications —> Clot Traveling to lung
- assess respiratory status!
- Preventing clot from getting bigger - anticoagulant
- Preventing more clots from forming - anticoagulant
Do you massage area where DVT is?
heck no
Venous thrombosis surgery
- In general, surgery is rare for venous thrombi =Thrombectomy
- Inferior vena cava filtration is more common
- use for people who cannot be anticoagulated for some reason
- prevents DVT from travling past inferior vena cava preventing PE
varicose veins =
Distended, protruding veins that become darkened and tortuous
*most common in >30 yr
varicose veins caused by and associated with
-Caused by: Prolonged standing or heavy lifting
-Associated with
Obesity
Estrogen
Family history
varicose veins assessment
- Itching
- Edema
- Feeling of fullness in legs
- Signs and symptoms of venous insufficiency
Varicose Veins diagnosis
- Ultrasonography
- Duplex ultrasonography
Varicose veins: Interventions
- Elevate
- Elastic Compression stockings
- Exercise
Varicose veins: surgery (3)
- Vein ligation or removal - tie the ends of the varicose vein and they collapse b/c no blood going through
- Sclerotherapy- injection of substance into vein causing sclerosis and blood moves somewhere else
- Endovenous ablation- runs catheter into vein, ablates it, vein goes away and blood uses healthier vein
