Term
| Predisposing factors to peripheral arterial disease |
|
Definition
***Smoking
-Hyperlipidemia, HTN
Coexisting CAD w/
-CHF
-Hx of MI
and Diabetes |
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Term
| What is peripheral arterial disease |
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Definition
| occlusive atherosclerotic disease of lower extremities |
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Term
| Sites of occlusion/stenosis in PAD |
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Definition
-superficial femoral artery
-popliteal artery
-aortoiliac occlusive disease |
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Term
|
Definition
-Intermittent claudication = good prognosis
-rest pain or ischemic ulcers = worst prognosis |
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Term
|
Definition
-Intermittent claudication
-Rest pain- often small arteries, at NIGHT, suggests severe ischemia |
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Term
|
Definition
-Diminished or absent pulses, muscular atrophy, dec. hair, thick toenails, dec. temperature
-Ischemic ulcers - often on toes, localized necrosis, 2' to local trauma doesn't heal, can become infected/gangrenous
-Pallor elevated, rubor when dependent |
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Term
|
Definition
1. Ankle-brachial index (ABI)
2. Pulse volume recording - assess limb perfusion
3. Arteriography *gold standard* dx PAD |
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Term
|
Definition
***Stop smoking
-Exercise program
-Foot care, especially diabetics
-reduce atherosclerotic risk factors- Hyperlipidemia, HTN, diabetes, weight
-Avoid extreme temps
-Aspirin w/ clopidogrel slight symptom improvement |
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Term
|
Definition
-Indicated w/ rest pain, ischemic ulcers, severe symptoms
1. Angioplasty w or w/o stent
2. Bypass grafting |
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Term
|
Definition
ratio systolic BP at ankle to arm
-Normal 0.9-1.3
>1.3 non-compresible vessels = severe dz
< 0.7 claudication
<0.4 rest pain |
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Term
| Cause Acute limb Ischemia |
|
Definition
1. Thrombus
2. Embolus
-trauma, compression, hematoma |
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Term
| 6 Cardinal signs of Acute limb ischemia |
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Definition
The 6 P's
1. Pain
2. Pallor
3. Polar (cold)
4. Paralysis
5. Paresthesia
6. Pulselessness |
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|
Term
|
Definition
1. Arteriogram - site of occlusion
2. ECG - look for MI, Afib
3. Echo - check valves, clots, MI |
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Term
|
Definition
**Assess ability to save limb viability of tissue
1. IV Heparin
2. Sx embolectomy, balloon, bypass if fail
3. Thrombolytics - mixed results |
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Term
| What is an aortic aneurysm |
|
Definition
localized dilation of aorta
-1.5Xs normal size |
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Term
| Risk factors Aortic Aneurysm |
|
Definition
Age
Men >women
trauma
HTN
vasculitis
smoking
family Hx
Syphilis
Connective tissue disorders (Marfan's) |
|
|
Term
|
Definition
Multifactorial
- atherosclerotic weakening of wall
-All three layers expand
-destruction of collagen and elastin from inflammation and wall stress |
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|
Term
|
Definition
1. Saccular- out-pouching of segment of vessel
2. Fusiform - circumferential expansion entire vessel |
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Term
|
Definition
-Usually asymptomatic
-Sense of "fullness
-May have pain |
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|
Term
|
Definition
-Pulsatile mass on exam
-Sudden severe pain radiates, ecchymosis = impending rupture |
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Term
| Signs of Abdominal Aortic Aneurysm |
|
Definition
Triad:
-Abdominal pain
- Hypotension
-palpable pulsatile abdominal mass
Also see syncope, N/V |
|
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Term
|
Definition
|
|
Term
|
Definition
-U/S best, see size and location
- CT- good but slower, good pre-op planning
-Radiograph - occasionally seen, not routinely used |
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|
Term
| Tx Aortic Aneurysm-unruptured |
|
Definition
Depends on size
>5cm or symptomatic - Sx resection w/ graft
<5cm or asymptomatic - controversial, monitor |
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|
Term
|
Definition
Emergent Sx repair
-open repair usually, some may be done endovascularly |
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Term
| Predisposing Factors Aortic Dissection |
|
Definition
-Longstanding HTN
-Cocaine use
-Trauma
-Connective Tissue diseases
-Bicuspid aortic valve
-Coarctation of aorta
-3rd trimester pregnancy |
|
|
Term
| Classification of Aortic Dissection |
|
Definition
Type A (proximal) - ascending aorta
Type B(distal) - descending aorta |
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|
Term
| Presentation of Aortic Dissection |
|
Definition
-Severe pain, ripping/tearing/stabbing
Type A-anterior chest pain
Type B- Interscapular chest pain
-Diaphoresis
-Usually Hypertensive, some Hypo
-asymmetrical BP and pulses
-Aortic regurge
-Neuro symptoms |
|
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Term
| How Tx Aortic Dissection-medically |
|
Definition
IMMEDIATELY
-IV B-blocker
-IV sodium nitroprusside |
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Term
| Tx Aortic Dissection Type A |
|
Definition
|
|
Term
| Tx Aortic Dissection Type B |
|
Definition
-Medical management
-Lower BP, B-blockers
-pain control
-if symptoms persist, may req. Sx |
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|
Term
| What genetic defects can lead to aortic dissection |
|
Definition
Connective Tissue Diseases
-Marfan's Syndrome
-Ehlers-Danlos Syndrome |
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Term
| Pathology of Varicose Veins |
|
Definition
valves do not function properly
blood to stay in the vein
pools causes the vein to swell |
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|
Term
|
Definition
| - swollen, twisted, and sometimes painful veins that have filled with an abnormal collection of blood. |
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|
Term
|
Definition
-Pregnancy
-Thrombophlebitis
-Birth defect valves |
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|
Term
| Symptoms of Varicose veins |
|
Definition
-Fullness, heaviness, aching, and sometimes pain in the legs
-Visible, swollen veins
-Mild swelling of ankles
-Brown color of the skin at the ankles (in more severe cases)
-Skin ulcers near the ankle (in more severe cases) |
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|
Term
| Tx Varicose Veins-general |
|
Definition
-Avoid standing for too long
-Raise your legs when resting or sleeping
-Wear elastic support hose |
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Term
| Tx Varicose Veins - Sx indicated |
|
Definition
-If pain / heaviness of legs
-skin ulcers
-cosmetic concern
-thickening of skin |
|
|
Term
|
Definition
Laser ablation
Radiofrequency ablation
Sclerotherapy (which is often done to improve appearance) |
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|
Term
| Presentation Superficial Phlebitis |
|
Definition
*Virchow's Triad
-Usually IV site UE
-Varicose vein LE |
|
|
Term
| S&S Superficial Phlebitis |
|
Definition
-Pain, tenderness, induration, erythema along vein
-Tender cord may be palpable |
|
|
Term
| Tx Superficial Phlebitis-localized thrombophlebitis |
|
Definition
mild analgesic
continue activity |
|
|
Term
| Tx Superficial Phlebitis - severe |
|
Definition
-Bed rest, elevation, hot compress
-When symptoms resolve - ambulation w/ compression hose
-If suppurative, Abx, drain ??
-Septic Phlebitis can be due to infected IV cannula, remove and systemic Abx |
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Term
| Chronic Venous Insufficiency |
|
Definition
-can be superficial, deep or both
-Often Hx DVT |
|
|
Term
|
Definition
-Destruction of venous valves from DVT or chronically elevated pressure
-leads to incompetence against gravity |
|
|
Term
|
Definition
-Leads to ambulatory venous HTN = edema and brawny discoloration
-reduced capillary flow and hypoxia of tissues
-Mild trauma can = tissue death
-Venous ulcers |
|
|
Term
|
Definition
-Swollen LE- worse at end of day or prolonged sitting/standing
-elevation of legs provides relief
-Skin thin, atrophic, shiny, cyanotic
-Brawny induration
-Venous Ulcers- often Medial malleolus |
|
|
Term
| Chronic Venous Insufficiency |
|
Definition
-can be superficial, deep or both
-Often Hx DVT |
|
|
Term
|
Definition
-Destruction of venous valves from DVT or chronically elevated pressure
-leads to incompetence against gravity |
|
|
Term
|
Definition
-Leads to ambulatory venous HTN = edema and brawny discoloration
-reduced capillary flow and hypoxia of tissues
-Mild trauma can = tissue death
-Venous ulcers |
|
|
Term
|
Definition
-Swollen LE- worse at end of day or prolonged sitting/standing
-elevation of legs provides relief
-Skin thin, atrophic, shiny, cyanotic
-Brawny induration
-Venous Ulcers- often Medial malleolus |
|
|
Term
|
Definition
-Leg elevation throughout day and night above heart
-avoid prolonged sitting/standing
-Can do Sx
-Diuretics |
|
|
Term
|
Definition
-Wet to Dry saline dressings
-Compression Hose, Unna boot
-Split-thickness skin graft may be needed |
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