ATI peripheral artery disease

what is PAD

progressive disorder that affects blood flow to the arteries in the lower extremities

common cause of PAD

atherosclerosis

other causes of PAD

lower extremity injury

blood vessel inflammation

radiation exposure

embolism/ thrombosis

vasospasms

risk factors of PAD

HTN

BMI >30

DM

hypercholesterolemia

elevated homocysteine

aging >50

smoking

family hx of cardivascular disease

s/s of PAD

discomfort

weakness

feet, leg, or hip cramps due to ischemia

if uncontrolled = neuropathy

safety consideration of PAD

fall risk from decreased walking endurance and balance due to ischemia

clinical persentation of PAD

most common: claudication (pain in buttocks, hips, thighs, calves, feet w/ walking)

pain that resolves w/ rest

Slow toenail growth decreased hair growth on the lower extremities

slow wound healing

pale and shiny appearance in the lower extremities

when extremity is dependent postion = red in color

lower extremity pulses are diminished or absent

bruits over iliac and femoral arteries

what is an ankle brachial index

confirms the assessment finding of decreased or absent pulses in lower extremities

uses doppler and gel

how to calcuate ABI

systolic ankle pressure of the highest reading of each leg is divided by highest systolic of either brachial systolic pressure

normal range of ABI

0.9 - 1.2

what does an elevated ABI range indicate >1.4

vessel stiffening

what does an decreased ABI range indicate <0.9

vessel narrowing

what is duplex ultrasonography

a noninvasive test to determine PAD presence, using a water-soluble gel to produce sound waves

environmental factors of PAD

environmental pollution = educate in reducing exposure, limit outdoor activity during highest pollution time

safety consideration for PAD

watch for manifestation of acute limb ischemia; the 6 P’s

(pallor, pain, paresthesia, paralysis, pulselessness, and poikilothermia) coolness of skin

Tx for PAD

Exercise therapy 30 -45 mins 3-4x/day for a min of 12 weeks

claudication meds

meds for PAD

cilostazol (pletal)

pentoxifylline (trental)

what is cilostazol

antiplatelet agent

what does cilostazol cause

vasodilation and has antiproliferative effects

what are contradictions of cilostazol

pt w/ congestive heart failure and can lead to fatal arrhythmias

what is pentoxifylline

hemorheolgic agent

what does pentoxifylline do

improve claudication by improving oxygen delivery to tissue

what are surgical interventions for PAD

balloon angioplasty or stent

sever s/s = bypass graft

endarterectomy = plaque removal