Unit 2 Week 5 PAD

Question 1

what is the cycle of PAD?

Answer 1

PAD ➙Leg pain ➙Decreased activity ➙Deconditioning ➙ PAD

Question 2

what are the factors leading to critical limb ischemia?

Answer 2

• Diabetic microangiopathy
• Atherosclerosis usually secondary to DM, HTN, or smoking
• CHF with severely decreased cardiac output
• Vasospastic diseases (Raynaud’s phenomenon, prolonged cold exposure)
• Smoking and other tobacco use
• Infection (abscess, cellulitis, osteomyelitis)
• Skin and soft tissue injuries

Question 3

what is critical limb ischemia characterized by?

Answer 3

• Pain at rest
• ABI usually ≤ 0.4
• Non-healing wounds and gangrene

Question 4

Interpretation of ABI Values
* ≥1.3
* 1.00 - 1.29
* > 1.1
* 0.91 - 0.99
* 0.41 - 0.90
* ≤0.4

Answer 4

• ≥1.3 are non-compressible; likely PAD; measure toe pressures
• 1.00 - 1.29 are considered WNL
• > 1.1 with risk factors and hx should be viewed with suspicion
• 0.91 - 0.99 are considered borderline PAD
• 0.41 - 0.90 are considered moderate to mild PAD
• ≤0.4 are considered severe disease correlating with critical limb
  ischemia

Question 5

what is the Segmental Pressures test?

Answer 5

BP measured along the LEs to localize an area of decline in systolic pressure
Relative lack of blood flow during diastole indicative of arterial disease

Question 6

what is exercise ABI testing?

Answer 6

• Confirms the PAD diagnosis
• Assesses the functional severity of claudication
• May detect PAD in the presence of normal resting ABI

Question 7

what is plantar flexion exercise ABI?

Answer 7

• Used if exercise ABI is impractical
• May be able to reproduce a treadmill-derived fall in ABI

Question 8

what vascular lab testing can be done for PAD?

Answer 8

• Color duplex ultrasonography: non-invasive
• Magnetic resonance angiography (MRA)
• Computed tomographic angiography (CTA)

Question 9

what is medical management for PAD?

Answer 9

• Smoking cessation
• Intensive antihypertensive therapy
• Clopidogrel (plavix):antithrombotic, blocking ADP receptors on platelets
• Aspirin: antithrombotic, less effective than plavix
• Cilostazol (pletal): phosphoesterase inhibitor produces vasodilation, inhibits platelet aggregation, not to be used for pts with CHF
• Pentoxifylline (trental): phosphoesterase inhibitor that improves blood flow through occluded areas and inhibits platelet aggregation, but does not improve walking distance as much as pletal

Question 10

what interventions are important for PAD?

Answer 10

• Education
• Exercise protocol for PAD
• Home exercise

Question 11

what should be a patient with PAD be educated on?

Answer 11

• Effect of elevating legs
• Energy conservation
• Signs of other arterial disease: CAD, CVA, CRI
• Exercise program

Question 12

what is the exercise protocol for PAD?

Answer 12

• 5-10 minute warm-up and cool-down each
• Treadmill or track walking
• Resistance exercise complementary, but not a substitute for walking
• Intensity: sufficient to cause claudication within 3-5 minutes
• Time: until moderately severe claudication reached
• Rest until claudication resolves in either sitting or standing

Question 13

what is the FITT plan for those with PAD?

Answer 13

• Frequency: 3–5 supervised sessions/week
• Intensity increased by either speed or grade to reach claudication in 3-5 min
• Time: 35 building to 50 minutes of walking each session + warm-up/cool down
• Up to 6 months
• Type: treadmill or track walking

Question 14

what are the surgical interventions that can be done for PAD?

Answer 14

• Critical limb ischemia or failure of conservative options
• Endovascular: placement of stent graft, usually for aneurysms
• Angioplasty with/without stents
• Thrombolysis
• Bypass grafting