PVD & Amputation

What is peripheral vascular disease (PVD)?

Abnormal functioning of the blood vessels that supply the extremities, major abdominal vessels (intestines and kidneys)

What is the difference between PAD and PVD?

• PAD only refers to arterial disease

• PVD refers to arterial and/or venous disease

What are some symptoms of PAD?

• Fatigue and weakness in the legs as blood flow decreases

• Intermittent claudication

• Sensory impairments

• Peripheral pulse distal to the occlusion is weak or absent

• Skin changes

  • Pale or cyanosis w/ elevated legs

  • Rubor or redness when legs in dependent positions

  • Dry, hairless, toenails thick & hard

What is an angioplasty?

Surgical process where a balloon or laser is used to open up an area with plaque

Angioplasty are best for what kind of blockage?

Stenosis

How does a bypass graft surgery work?

A vein or synthetic graft is used to bypass an occluded area and reroute blood flow

What kind of blockage do bypass graft surgeries work best against?

Occlusions

Bypass graft surgeries are immediately successful in ____% to ____% of cases

90-95%

When working with a pt who has just had a revascularization procedure, what should you focus on?

• Screening for distal pulses

• Examining skin color

• Ambulation to facilitate blood flow

After a pt has had a revascularization procedure, they limb is often worse than it was pre-surgery. True or false?

False! The limb is often better after the surgery

How many people in the US live with limb loss?

2 mil

What are the causes of limb loss in descending order?

• Vascular disease (DM & PVD) 54%

• Trauma (motorcycle, auto v pedestrian, blast injury) 45%

• Cancer 2%

Nearly half of people who have an amputation due to a vascular disease will die within ___ years

5

In people with diabetes w/ a LE amputation up to ___% will require amputation of the other limb in 2-3 years

55%

Why does gangrene often lead to amputation?

Due to underlying vascular disease where blood flow is gone

What causes gangrene?

A lack of blood flow or a serious bacterial infection

What are some risk factors for gangrene?

• Having atherosclerosis

• Having DM

What are the S/S of gangrene?

• Skin discoloration (pale, blue, purple/black, bronze, red)

• Swelling or formation of blisters w/ fluid (wet)

• Clear line between healthy and damaged skin

• Sudden, severe pain followed by numbness

• Foul-smelling discharge from wound

• Thin, shiny skin w/o hair

• Skin cool or cold to touch

What are the different types of gangrene?

• Dry

• Wet

• Gas

• Fournier’s

Describe dry gangrene

• Dry tissue that shrinks and blackens

• Skin becomes hard

• Hardly any infections

What type of gangrene will you hardly see an infection?

Dry gangrene

Describe wet gangrene?

• Tissue gets cold, swollen w/ blisters that are filled w/ fluid

• Moist in appearance

• Red, warm tissue

• Foul odor

• Always infected

What kind of gangrene will you always see an infection?

Wet

Describe gas gangrene

• Build-up of gases within tissue and further reduces blood supply

• Severe pain and fever

• Skin cracks when pressed like bubble wrap

Describe Fournier’s gangrene

Gangrene of the genitals

Can dry gangrene become wet?

You bet! If it gets infected

What can wet gangrene cause if the infection spreads?

Septic shock

What is the goal of a surgeon when doing an amputation?

Leave as much viable tissue as possible

What are the different types of LE amputations?

• Toe

• Ray

• Transmetatarsal

• Syme’s amputation

• Transtibial

• Knee disarticulation

• Transfemoral

• Hip disarticulation

• Hemipelvectomy

How are the nerves delt with in a transtibial amputation?

Periphreal nerves pulled taut and then cut sharply (decreases pain at weight bearing surface)

Why might a knee disarticulation be done more commonly in children?

To preserve the growth plate

What is the most common cause of a hip disarticulation?

Trauma

Vascular diseases more commonly cause people to lose an UE rather than a LE. True or false?

False! Vascular diseases more commonly take a LE

What are some causes of UE amputations?

• Trauma

  • Auto collisions, industrial or farming

• Penetrating trauma

• Congenital limb deficiency

What are the different types of UE amputations?

• Fingers/thumb

• Wrist

• Transradial

• Elbow

• Transhumeral

• Shoulder

• Forequarter

What are the goals of therapy when working with someone who has an acute amputation?

• Facilitate functional mobility

  • Changes to COM affect balance & gait

• Optimize strength and ROM to prepare for prosthetic training

• Edema control and pain management

• Wound healing

  • Increased time needed if PAD or DM present

• Prosthetic training occurs in OP primarily

What is phantom limb sensation?

Any sensation in the residual limb except pain. May think the limb is still there

What is phantom limb pain?

Type of neuropathic pain where there is painful sensations in the missing limb as if they were still intact

When are ratings of depression highest in those who have had an amputation?

• Right after the surgery

• 1-2 years later