Overview of Peripheral Vascular System

Intermittent claudication

Cramp-like pain with activity due to arterial insufficiency (↓ blood flow → lactic acid buildup) that is relieved with rest

Rest pain (PAD)

Severe ischemic pain at rest (often at night) relieved by dangling the limb, indicating advanced arterial insufficiency

Depdendent rubor

Redness when limb is dependent due to blood pooling from poor arterial flow, with pallor on elevation

Chronic arterial insufficiency changes

Hair loss, brittle nails, dry skin, ulcers that can progress to gangrene

Arteriosclerosis

General hardening/thickening of small arteries/arterioles

Atherosclerosis

Plaque buildup (lipids, calcium, fibrous tissue) in large/medium arteries; often with arteriosclerosis

Fatty streaks

Early sign of atherosclerosis, able to be reversed w/ lifestyle changes

Fibrous plaques

Advanced, less reversible, cause obstruction and thrombosis

PAD Nursing management

Exercise (esp. walking) helps with intermittent claudication w/ permission, weight loss, smoking cessation, avoid constrictive clothing or heat

PAD medications

Cilostazol (vasodilation), antiplatelets, statins

PAD procedures

Angioplasty and stenting, bypass grafting, endarterectomy (removes plaque)

Peripheral Arterial Occlusive Disease (PAD)

Narrowed/block arteries in limbs (legs) → reduced blood flow → intermittent claudcation, rest pain, skin changes, ulcers, gangrene

Saccular

Bulge on one side

Fusiform

Entire circumference dilated (both sides)

Aneurysm

Localized sac or dilation formed at weak point in wall of artery due to atherosclerosis, connective tissue disorder, or hemodynamic issue

Thoracic Aortic Aneurysm

Often atherosclerotic (70%; 50-70yos) w/ pain, dyspnea, cough, dysphagia