Week 7 Flashcards
What is peripheral artery disease?
narrowed arteries reduce blood flow to the limbs
causes symptoms, most notably claudication
PAD is likely to be a sign of a more widespread accumulation of:
fatty deposits in other arteries as well as heart and carotids
(can also be from vessel inflammation, injury to limbs, unusual anatomy of your ligaments or muscles, or radiation)
If PAD is caused by buildup of plaque, there is also a risk of developing:
critical limb ischemia
begins as open sores that don’t heal, injury or infection on feet/legs. Can lead to gangrene
Where’s the most common location for claudication? What level is the obstruction with this?
calf pain
obstruction is above this level in the PopA or FemA
What are some PAD symptoms?
claudication leg numbness/weakness coldness in lower leg sores on toes/feet/legs that won't heal change in color on legs hair loss/slower hair growth slower growth of toenails shiny skin on legs no pulse/weak pulse on legs ED in men
What are the 5 P’s associated with critical limb ischemia?
pain pallot (pale skin) pulselessness paresthesia paralysis
Arterial ulcers are located:
borders/sides of foot
lateral
Neuropathic ulcers are located:
plantar surface of foot
Venous ulcers are located:
medial aspect of leg superior to medial malleolus
Palpation:
temperature- cool suggests poor circulation, sides should be compared
pitting edema- should be tested in dependent locations-dorsum of foot, shins, etc.
Ausculation:
for FA bruits, listening with a stethoscope in the groin area for wooshing sounds
Arterial pulses:
dorsalis pedis artery pulse- dorsal surface of foot (running lateral on the tendon on the first toe)
posterior tibilar artery pulse- posterior and inferior to the medial malleolus
popliteal artery pulse- behind the knee
FemA pulse- in fem triangle/halfway between the ASIS and pubic tubercle
A sonographer should visually assess for:
shiny skin
hairlessness (esp on toes)
ulcers on foot
asymmetry of limbs
What assesses peripheral vascular disease?
Ankle brachial pressure indev
but may be unreliable in patients w/ calcified arteries or extensive edema–so then use TBPI
With arterial bypass graft the are several places we perform Spectral doppler:
prox to anastomosis (inflow) prox anastomosis prox graft mid graft distal graft distal anastomosis outflow artery
If peripheral artery disease progresses, the patient may experience:
(after claudication)
rest pain
What are risk factors for PAD
smoking diabetes obesity BMI>30 high BP (140/90) high cholesterol (>240mg/dL) inc age family hx high levels of homocysteine
What is homocysteine:
a protein component that helps build and maintain tissue
People who smoke or have diabetes have the greater risk of developing:
PAD due to reduced blood flow
What are signs of PAD?
weak/absent pulse in narrowed area of artery
whooshing sounds/bruits
evidence of poor wound healing
dec BP
Blood testing for PAD measures what in the blood:
triglycerides and cholesterol
Angiography:
injecting a contrast material into the blood vessels, allows a specialist to view blood flow through the arteries
then imaging techniques such as X-ray, CTA, or MRA
allows for simultaneous diagnosis and treatment
Treatment for PAD:
non-diabetic
cholesterol lowering meds high BP medi angioplasty bypass surgery thrombolytic therapy
Treatment for PAD:
diabetic
meds to control blood sugar
medications to prevent blood clots
