PVDs Flashcards
Peripheral Vascular Disease
Umbrella term describing several circulatory diseases
It’s only Peripheral ARTERIAL Disease (PAD) when
ONLY the arteries are affected
PVD Pathophysiology
- Lower Extremity Atherosclerosis
- Ischemia reperfusion of calf skeletal muscle
- Reduced myofibers in calf muscle
- Impaired mitochondrial function
- Muscle damage and degeneration
- Impaired peripheral nerve function
- Impaired oxygen consumption
- reduced leg strength - Poor 6-minute walk test
- -Increased rates of mobility loss
PVD in a nutshell
Atherosclerosis processes in extremities. Just like CVD
PVD + PAD: Risk factors
**Smoking (4x) Diabetes High cholesterol Stroke Heart disease Age >50
Common causes of PVD
- ATHEROSCLEROSIS
- A Thrombus
- Inflammation
- Thromboangitis Obliterans: an inflammatory condition of the arteries - Vasospasm
- Raynaud’s disease or phenomenon an autoimmune disease
Peripheral Arterial Sclerosis (PAD): Clinical manifestations
*d/t local tissue ischemia
- Calf + buttock pain
- numbness/burning
- heaviness
- intermittent claudication - Wounds that don’t heal
- Diminished sensation in extremities
- Trophic skin changes
- Skin: shiny, thick toenails
- loss of leg hair
- elevation pallor
- reactive hyperemia (dependent rubor)
- erectile dysfunction
Intermittent claudication
Pain when people are walking
- Stops with rest
- caused by ischemic tissue from arterial flow obstruction
Pain depends on:
- Site of plaque buildup
- collateral circulation
“angina of lower extremity”
Common Site of PAD:
FEMORAL ARTERY
Lack of circulation:
- Pain (claudication)
- Decreased pulse
- Coolness of leg
- Pallor of leg
- Loss of sensation in foot
Ischemia of muscle in lower leg causes cellular hypoxia
The 5 P’s of PAD
Pain (claudication) Pulselessness Palpable coolness Paresthesia's Paresis (weakness of extremity)
Diagnosis of PAD
Ankle-Brachial Index
- comparison of the blood pressure in the leg vs arm
- Normal ratio: >1
- Normal: ankle pressure is greater than brachial pressure
Severe PAD: ABI=0.5 or less
Arterial Ulcers
Claudication No edema No pulse or weak pulse No drainage Round smooth sores Black eschar
Location: Toes and Feet
Venous Ulcers
Dull achy pain Lower leg edema Pulse present Drainage Sores with irregular borders Yellow slough or ruddy skin
Location: Ankles
Arterial Insufficiency (PAD)
Narrowing of the arteries, commonly in pelvis and legs
Cramping, pain, tired legs or hip muscles that worsens during walking/activity and subsides with rest
Venous Insufficiency (PVD)
Inadequate return of venous blood from the legs to the heart
Tires/heavy, achy cramping in the legs. Pain worsens when standing and improves with leg elevation and activity
What is Chronic Venous Insufficiency?
A condition that occurs when the VENOUS wall and/or VALVES in the leg veins are not working effectively
CVI causes blood to ‘Pool’ or collect in these veins (venous stasis)
Affects 40% of US
Chronic
Venous Insufficiency: Symptoms
- Lower extremity edema
- Achiness or tiredness in legs
- Leathery looking skin
- Stasis ulcers
- Flaking or itching skin
- New varicose veins
Nonpharmacological Treatment of PVD (and PAD)
SMOKING CESSATION Increase physical activity Weight reduction Stress reduction Hypertension control Diabetes management
Interventions aimed at occlusion in PVD
- Balloon stent
2. Bypass…
Pharmacological Treatment of PVD
Antiplatelet agents
Anticoagulants
Thrombolytics
Lipid lowering agents
*Agents that increase blood supply to extremities
*Agents that increase blood supply to extremities
Cilostazol (Pletal)
Cilostazol (Pletal): Indication
Treatment for Intermittent claudication
Cilostazol (Pletal): MOA
Platelet inhibitor
Vasodilation
Cilostazol (Pletal): AE
Headache (30%), dizziness
Diarrhea, abnormal stools
Palpitations, peripheral edema
Drug interactions: P450
Pentoxifyllinne (Trental): Class
Vasoactive agent
Pentoxifyllinne (Trental): Indication
Intermittent claudication
Pentoxifyllinne (Trental): MOA
Relieves leg pain by increasing blood flow and oxygen through the blood vessels. helps increase walking distance and duration
Pentoxifyllinne (Trental): AE
N/V and Dizziness
PO 3x a day
