11 17 2014 Peripheral Arterial Occlusive Disease Flashcards Preview

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Peripheral Arterial Occlusive Disease

Presence of flow-limiting lesion in an artery that provides blood supply to the limbs


Etiology of Peripheral atherosclerotic vascular disease

1. Atherosclerosis (most common)
2. Thormboembolism
3. Vasculitis

15-20% of patients are over the age of 70
40% of people with PAD have clinically significant CAD


Atherosclerotic limb

At rest: BP at ankle is less than that of a healthy person

With exertion the reduction in pressure produced by atherosclerotic lesion becomes more significant and the distal pressure is greatly diminished.

Stenotic vessel cannot supply enough blood to limb that has an increase demand ( exercise)

Atherosclerotic endothelium does not release normal amounts of vasodilating substances
- stenosis plus decrease in vasodilating substances = ischemia


Clinical Presentation of Atherosclerotic Limb
(aka what patients complain of)

- Pain with exertion (claudication)
* correlates to blocked artery
-usually goes away with rest (2-3min)

- Rest pain (sever -- limb threatening ischemia)
- Non-healing wounds ( due to inadequate blood supply)


Muscle adaptation to ischemia

- denervation
- muscle wasting and strength is decreased


Clinical signs of atrial insufficiency
(aka what you will see)

Atrophy of calf muscles
Thickened toes
Loss of hair below the knees
Thin, shiny skin
Non-healing wounds
Dependent rubor


Ankle- Brachial Index

Cuffs at arms and ankles -- ratio between Ankle/Arm pressure

normally: ankle pressure is higher than arm pressure

Exercise begins, no change in measured blood pressure occurs in the healthy extremity

<.5 ratio


Acute Limb Ischemia -- Five P's



Neurogenic claudification

1. cause
2. how to relieve pain and what causes the pain
3. Symptoms?
4. What are the areas usually affected?
5. History key points?

Spinal Stenosis

-Pain is relieved when the patient flexes the spine by sitting. (or just changing positions)
* ischemia of nerve roots + narrowing of spinal canal

symptoms as claudication OR tingling, weakness, or clumsiness

Areas: buttock, hip, thigh

History: lower back pain problems in the past