PAD 2 Flashcards
Describe HPI findings of Peripheral arterial disease
- Claudification
- cramping and pain in legs with walking a certain distance
- diaetics may have leg fatigue instead of pain
- rest pain = cramping in legs when elevated, relieved with dependent position
- “black” ulcers or toes
- Chronic ulcers that don’t heal
- painful ulcer despite neuropathy
what are some PAD risk factors
- diabetes
- coronary artery disease
- hypertension
- hyperlipidemia
- obesity
- aortic aneurism
- age
- race (hispanic, african american, male gender)
diabetic risk factors of PAD
- Metabolic syndrome
- hyperinsulinemia or hyperglycemia
- hypertriglyceridemia
- hypertension
- obesity (waist line > 40inches in males, > 35inches in females
- every increase of 1% of HgA1c, risk factor for PAD goes up 28%
what are some social risk factors of PAD
- coronary artery stent placement or lwoer extremity stent placement
- *- TOBACCO USE**
- any family with history of risk factors or PAD
what are some dermatology physical signs of PAD
- Skin thin, atrophic
- back of pedal hair
- brittle rigid nails
- cold
- hemosiderin deposits (brown spotting in the lower legs = red blood cells are breaking aprt and the hemosiderin causes staniing of brown spots)
- may have waxy appearane
- Ulcers (gangrenous; granular with a lot of fibrotic tissue)
Vascular signs of PAD
- Dependent rubor = foot looks red when dependent, pale when elevated)
- Capillary refill time is greater than 3 seconds
Describe the Doppler exam
- Normal: Triphasic
–> normal arterial flow and usually associated with a palpable pulse
- Biphasic = mild to moderate PAD (2 sounds)
- monophasic or absent (severe PAD)
describe ankle brachial index
- ABI = lower extremity systolic pressure/brachial artery systolic pressure
–> greater than 1.3 = false elevation; heavy vessel calcification
–> .9-1.3 = normal
–> .5-.9 = peripheral artery disease; associated with intermittent claudication
–> less than .5 = critical limb ischemia; associated with ulceration and rest pain
describe segmental pressures
- multiple cuffs along lower limb
- guidelines for obstruction
–> 20-30mmHg difference between adjacent cuts signifies PAD
- -> 30 mmHg change along leg from thick to ankle signifies PAD
- -> 20mmHg or more difference between opposite leg, same level signifies PAD
describe doppler ultrasound for PAD
- Pitch = function of how fast blood cells moving
–> faster the cells move the higher the pitch
- Loudness = function of how many blood cells the waves hit
–> the more cells hit the louder the sound
PVD treatment
- Medical therapy
- Antiplatelet therapy (aspirin or clopidogrel)
- LDL cholesterol level of less than 100mg/dL
- HgA1c of less than 7%
- Control of hypertension (possible benefit of ACE inhibitor)
- Tobacco cessation
- Endovascular therapies (stenosis at all levels, short segment occlusions)
- Surgical bypass (long segment occlusions
- Surgical endarterectomy (occlusion or high grade stenosis at common femoral bifurcation
