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Peripheral Vascular Disease

Peripheral Vascular Disease

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Peripheral Vascular Disease

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  1. Peripheral Vascular Disease Christopher B. Powe

  2. Objectives • Definition of Peripheral Vascular Disease • Etiology/Incidence of Peripheral Vascular Disease • Signs and Symptoms of Peripheral Vascular Disease • Diagnosis of Peripheral Vascular Disease • Treatment for Peripheral Vascular Disease

  3. Risk Factors Non Modifiable Modifiable Smoking (A/V) HTN DM (A/V) Obesity Type A personality Oral contraception hyperlipidemia • Age • Gender male>female (A/V) • Race • Heredity

  4. Definition/Incidence • Disorder of peripheral arteries and viens • Commonly in lower extremities • One in five adults • Two categories • PAD • CVI

  5. Definition of Peripheral Vascular Disease • Peripheral arterial disease • Manifestation of systemic arthrosclerosis in which there is a partial or total blockage in the arteries, exclusive of the coronary and cerebral vessels. Defined as resting ankle-brachial index of < 0.90 • Occlusion arterial disease • Two forms of disorders. • Arteriosclerosis obliterans – Narrowing of the lumen in the artery that results from arteriolsclerosis • Thromboangiitis obliterans (Buerger’s disease) –Occlusion of the arteries that results from thrombosis and inflammation

  6. Definition Peripheral Venous Dx • Condition in which alteration in the character of veins results in thrombosis or decreased venous return • Superficial thrombophlebitis or deep thrombosis of veins

  7. Subjective/Physical Finding Arterial Dx Venous Dx Dependent edema Leg edema Shiny taut skin Hyperpigmentation Ulcers • 6 “P’s” • Pain • Pallor • Pulse absent • Parasthesia • Paralysis • Poikilothermia • Loss of hair to extremity effected • Glossy skin

  8. Peripheral Artery DiseaseSigns & Symptoms • Approximately half are asymptomatic • Intermittent claudication, particularly calf pain, that most often starts at the arch of the foot. (symptoms resolve in 2-5 minutes after rest) • Pain at rest • Pain relieved by dependent positioning • Coldness, numbness, or pallor of the extremity • Absent or diminished pulse, especially distal • Ulcerations of the feet or toes • Reduced pulses • Dependent Rubar • Dry scaly skin • Poor nail growth • Hair loss.

  9. Peripheral Venous Signs & Symptoms Superficial vein Deep vein Throbbing aching extremity Tender to touch Homan’s sign Fever Edema • Palpable cord, red vein • Tender, warm • Fever 70%

  10. Diagnostic Work-up Artery Dx Venous Dx Doppler plethysmography Venography • Doppler ultrasound • Arteriogram

  11. Management Artery Dx Venous Dx Elevation Warm compress NSAIDS/analgesics Bed rest Anticoagulation Possible fibrinolytic therapy if indicated IVC filter exercise progression gradually WT reduction Skin care • Balloon/laser angioplasty • Pain control • Artherectomy • Bypass • ASA • Consider Pletal • Trental 3 times daily for those able to ambulate and exercise before claudication • Smoking cessation • Control HTN, DM • Foot care

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