Peripheral Artery Disease - PVD Flashcards by Jawric Cuyzon

What are the risk factors?

CAD/artheroscleorisis
advanced age
hypercholesterolemia
smoking
hypertension
diabetes
overweight
family hx

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What are the characteristics of patients with increasd risk of PAD?

65 years and over
50-64 with risk factors of artherosclerosis or family hx of PAD
under 50 with DM and 1 risk factor for atherosclerosis
with known atherosclerotic disease
AAA - abdominal aortic aneurysm

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Pathohysiology

What is the assumed cause?

mismatch of demands of the body’s organs and muscles with supply of O2
- this is because of atherosclerotic stenosis of peripheral arteries

reduced diameter of blood vessels = ischemia

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Pathophsysiology

What occurs during exercise?

metabolism makes adenoside -> dilation of arterioles = increase blood flow to muscles

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Pathophysiology

What is another factor that leads to ischemia?

obstructed arteries which can’t act well to vasodilation stimulus and blood flow
- dramatic reduction to exercise tolerance

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Pathophysiology

Local adaptations to chronic ischemia will lead to changes in what?

Muscle fiber metabolism and skeletal muslce degeneration

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Pathophysiology

What can lead to lower extremity weakness?

Physical and biomechanical changes

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Pathophysiology

What does ischemic changes in multiple arteries lead to?

ischemic sx at rest (very similar to angina)

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Clinical Presentation

What are the vessels most commonly affected?

aorta
iliac femoral
popliteal
tibialperoneal arteries

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Clinical presentation

What vessels are affected if there is arm pain?

brachiocephalic or subclavian

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Clinical Presentation

Where is intermittent claudication affected?

buttock
hip
thigh
calf pain
sometimes feet and toes

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Clinical presentation

What is the prevalence of intermitted claudication?

only about 1/3 experience it
about 1/3 experience atypical sx
about 1/3 are asx

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Clinical presentation

What are the atypical sx?

leg pain/carry on - able to keep exercising through the pain or pain that starts at rest w/o critical limb ischemia

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Clinical Presentation

Where is the location of sx?

Distal to the stenotic artery

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Chronic Presentation

Chronic ischemia leads to?

Ulceration, infection and skin necrosis

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Clinical Presentation

What are the clinical presentation?

dimished or absent pulses distal to stenosis
muscle atrophy
pallor or reduced temp when elevated (rubor of dependency)
shiny, taut skin - typically with hair loss and brittle, thick, dry toenails (trophic changes)
wounds
gangrene
necrosis of foot and digits
reduced sensation
associated with diabetes

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ACSM Intermittent Claudication Scale

Grade 1

Definite discomfort or pain
- but only initial or modest levels

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ACSM Intermittent Claudication Scale

Grade 2

Mod discomfort or pain from which the patient attention can be diverted

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ACSM Intermittent Claudication Scale

Grade 3

Intense pain from which the patient’s attention can’t be diverted

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ACSM Intermittent Claudication Scale

Grade 4

Excuciating and unbearble pain

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Ankle Brachial Index

What is considered normal measurement?

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greater than 1.10

Ankle Brachial Index

0.5 - 1.0

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sx: claudications

clinical presentation: pain in calf with ambulation

Ankle Brachial Index

0.2-0.5

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sx: critical limb ischemia

clinical presentation: atrophic changes, pain at rest, wounds

Ankle Brachial Index

less than 0.2

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sx: severe ischemia

clinical presentation: gangrene, severe necrosis

What is critical limb ischemia?

Progression of PAD - circulation can't meet resting metabolic demands - in early stages - collateral circulation will compensate

# Critical Limb Ischemia 1st critical phase

When collateral circulation can't meet the needs of metabolic demand - limited blood supply will affect muscles and skin = wound will be compromised

# Critical Limb Ischemia 2nd critical phase

Pain is experienced with exercise - increasing muscle O2 demand

# Critical Limb Ischemia 3rd critical phase

Seen with resting pain - non-healing wounds - risk to infections - risk for gangrene

What is acute cold leg?

When there is an acute arterial occlusion - a vascular emergency = longer delay will lead to amputation

# Acute Cold Leg What is the cause of acute cold leg?

in situ thrombic occlusion - most often in femoral artery or embolism

# Acute Cold Leg What are the sx?

sudden onset of: - cold - pale - pulseless - painful - parasthetic - paralytic leg

# Acute Cold Leg How is it treated medically?

with revascularization

# Acute Cold Leg What is the indication for an amputation?

- mottled - non-blanching with hardened, woody muscle

# Clinical Categories of Acute Limb Ischemia What is the prognosis of IIA (marginally threatened)?

salvageable - if promptly treated

# Clinical Categories of Acute Limb Ischemia IIA - sensory loss

minimal (at toes) or none

# Clinical Categories of Acute Limb Ischemia IIA - possible doppler

arterial - inaudible venous - audible

# Clinical Categories of Acute Limb Ischemia IIB (immediately threatened) - prognosis

salvageable if immediately revascularized

# Clinical Categories of Acute Limb Ischemia IIB - prognosis

Salvageable if immediately revascularized

# Clinical Categories of Acute Limb Ischemia IIB - sensory loss

more than toes, pain at rest

# Clinical Categories of Acute Limb Ischemia IIB - motor deficit

mild to moderate

# Clinical Categories of Acute Limb Ischemia IIB - possible dobler

arterial - inaudible venous - audible

# Clinical Categories of Acute Limb Ischemia III (irreversible) - prognosis

Major tissue loss permanent nerve damage nerve damage inevitable

# Clinical Categories of Acute Limb Ischemia III - sensory loss

profound loss

# Clinical Categories of Acute Limb Ischemia III - motor deficits

profound, paralysis

# Clinical Categories of Acute Limb Ischemia III - possible dopplers

both inaudible dopplers for arterial and venous

# ACSM Guidelines What is the guideline for aerobic activity?

3-5x per week @ RPE 12-16 for 20-60 min per session - walking speed should be at a pace to elicit caludations in 3-5 mins

# ACSM Guidelines What is the guideline for resistance activity?

2x per week - focusing on larger muscle - emphasis on lower limbs

# ACSM Guidelines What is the guidelines for flexibility?

2-3x per week

What are the surgical interventions for PAD?

- angioplasty with/or without stent - bypass surgery - femoral popliteal bypass

When is exercise resumed after an angioplasty?

generally improved right away and helps with healing of distal wounds - exercise can resume 72 hrs post

When is exercise resumed after bypass surgery?

sx should resolve and out of bed after 1 day - encourage activity once the wounds heal - limit lifting for 6 weeks

When is exercise resumed after femoral-popliteal bypass surgery?

used for critical limb ischemia - OOB walking after day 1 post op - go back to activity once wounds heal - monitor limb tthrough healing

Peripheral Artery Disease - PVD Flashcards

(52 cards)