Vasc- peripheral arterial testing PT 1 Flashcards
What is PAD- peripheral arterial disease?
- a common circulatory problem in which narrowed arteries reduce blood flow to limbs
when someone develops PAD what occurs?
- the extremitites (usually legs) don’t receive enough blood flow to keep up with demand
muscle cells require oxygen constantly when exercising T or F?
T
what is the most common symptom of PAD?
- leg pain when walking (intermittent claudication)
what is intermittent claudication?
leg pain when walking
PAD is likely to be a sign of a more widespread accumulation of what?
- fatty deposits in other arteries as well as the heart and carotids
PAD may be reducing blood flow to what parts of the body? (3)
- heart
- brain
- limbs
what is a less common cause of PAD (4)?
- blood vessel inflammation
- injury to limbs
- unusual anatomy of ligaments or muscles
- radiation exposure
If peripheral artery disease is caused by a buildup of plaques in the blood vessels (atherosclerosis), there is also at risk of developing what?
critical limb ischemia
what does critical limb ischemia begin as (3)?
- open sores that don’t heal
- an injury
- infection of feet or legs
how does critical limb ischemia progress?
- can cause tissue death (gangrene)
- sometimes requires amputation of affected limb
complications of PAD (5)?
- critical limb ischemia
- gangrene
- amputation
- stroke
- heart attack
intermittent claudication symptoms?
- muscle pain or cramping in legs or arms triggered by activity but disappears after a few minutes of rest
what does the location of claudication depend on?
- location of clogged or narrowed artery
Calf pain is the most common location indicating the obstruction is where?
- above this level in the popliteal or femoral artery
peripheral artery disease symptoms? (10)
- claudication/ altered gait
- leg numbness or weakness
- coldness in the lower leg or foot
- sores on toes, feet, or legs that won’t heal
- change in color of the legs
- hair loss on feet and legs
- slower growth of toenails
- shiny skin on legs
- no pulse or weak pulse in legs or feet
- erectile dysfunction
where are arterial ulcers typically seen?
- tend to be on borders/ sides of the foot
where are neurpathic ulcers typically seen?
on the plantar surface of the foot
where are venous ulcers typically seen?
medial aspect of the leg superior to the medial malleolus
what is physicians role in palpation (physical evaluation touching with hands)? (2)
- Tempurature- cool suggesr poor circulations, sides should be compared
- pitting edema- should be tested for independent location- dorsum of foot, if present then on shins
physicians role in auscultation (listening)?
- search for femoral artery bruits: listen with stethoscope in groin area for wooshing sounds
what artieral pulses should a physician check for in arterial testing? (4)
- dorsalic pedis artery
- posterior tibial artery
- popliteal artery
- femoral artery
what is the dorsalis pedia artery pulse found?
- on dorsal surface of the foot
- runs lateral to the tendon of the 1st toe
where is the posterior tibial artery pulse located?
- posterior and inferior to the medial malleolus
where is the popliteal artery pulse located?
- behind the knee, typically done with both hands
where is the femoral artery pulse located?
- in the femoral triangle
- halfway between the ASIS and pubic tubercle
Prior to beginning the arterial test, the sonographer is responsible for what?
- taking history and visually assessing patients legs
what questions should the sonographer ask before arterial testing? (4)
- have you had any surgury to your blood vessels such as grafts of tripping of veins?
- how far can you walk before the pain starts?
- does the pain subside when you stop to rest?
- does it return when you resume walking?
what should sonographers visually assess for in lower extremity arterial testing? (4)
- shiny skin
- hairlessness especially on toes
- ulcers on foot (diabetics)
- asymmetry of limbs
ankle-brachial pressure index (ABPI) assesses what?
peripheral vasular disease
when is ABPI unreliable?
- in patients with calcified arteries in the call (often diabetic patients) or those with extensive edema
when ABPI is unreliable what should be performed?
toe brachial pressure index (TBPI)
what is rest pain? what is it also known as?
- if peripheral artery disease progresses, pain may even occur when at rest or lying down
- may be intense enough to disrupt sleep
- AKA ischemic rest pain
what relieves ischemic rest pain?
- hanging legs ober edge of bed
- walking around room may temporarily relieve pain
risk facotrs of PAD?
- smoking
- diabetes
- obesity (body mass over 30)
- High BP (140/90 mmHg or higher)
- high cholesterol (>240 mg per dL, or 6,2 milimoles per liter)
- increasing age
- family history of PAD, heart disease, stroke
- high levels of homocysteine
what is homocysteine?
protein component that helps build and maintain tissue
what people have the highest risk of developing PAD sue to reduced blood flow?
- people who smoke or have diabetes
Some of the tests a doctor may rely on to diagnose peripheral artery disease are? (5)
- physical exam
- ABI
- Ultrasound
- blood tests
- angiography
signs of PAD on physical exam?
- weak or absent pulse below a narrowed area of the artery
- bruits over the arteries
- evidence of poor wound healing in the area where blood flow is restricted
- decreased blood pressure in the affected limb
PAD with ABI?
- common test used to diagnose PAD
- compares the blood pressure in the ankle with the blood pressure in the arm
- walking on treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking
how do blood tests contribute to PAD?
- a sample of the blood can be used to measure cholesterol and triglycerides and to check for diabetes
what is angiography?
- injecting a dye (contrast material) into the blood vessels, allows a specialist to view blood flow through the arteries as it happens
the flow of contrast material is used with imaging techniques such as?
- X-ray
- MRA
- CTA
what is catheter angiography?
- a more invasive procedure that involves guiding a catheter through an artery in the groin to the affected area and injecting the dye that way
- allows for simultaneous diagnosis and treatment
- Finding the narrowed area of a blood vessel and then widening it with an angioplasty procedure or administering medication to improve blood flow
Treatments for PAD? (7)
- cholesterol-lowering medications
- high blood pressure medications
- medication to control blood sugar
- medications to prevent blood clots
- angioplasty
- pypass surgery
- thrombolytic therapy
what is cholesterol-lowering medications?
- A cholesterol-lowering drug called a statin to reduce the risk factor of heart attack and stroke
what are high blood pressure medications?
- The goal of this therapy is to reduce the systolic blood pressure to 140 millimeters of mercury (mm Hg) or lower and the diastolic blood pressure to 90 mm Hg or lower
if a patient has diabetes the blood pressure target is?
under 130/80 mmHg
when to use medication to control blood sugar?
If the patient also has diabetes, it becomes even more important to control the blood sugar (glucose) levels
what are medications to prevent blood clots?
- Because peripheral artery disease is related to reduced blood flow to the limbs, it’s important to reduce the risk of blood clots
- A blood clot can completely block an already narrowed blood vessel and cause tissue death
– Plavix is a common drug
what is a common medication to prevent blood clots?
plavix
angioplasty or surgery may be necessary to treat?
PAD that is causing intermittent claudication
what is angioplasty?
- a catheter is threaded through a blood vessel to affected artery
- small balloon don’t he tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while stretching the artery open to increase blood flow
- the doctor may insert a mesh stent in the artery to help keep it open
- this is the same procedure used to open heart arteries
what is bypass surgery?
- The doctor may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric
- This technique allows blood to flow around — or bypass — the blocked or narrowed artery
what is thrombolytic therapy?
If there is a blood clot blocking an artery, the doctor may inject a clot-dissolving drug into the artery at the point of the clot to break it up
