Signs and Symptoms of LEA disease

Risk factors for arterial disease

Smoking (causes vasoconstriction), hyperlipidemia, family Hx, Diabetes, Systemic HTN, sedentary lifestyle, age, males have higher risk

Etiology of arterial ischemia

Atherosclerosis causes stenosis and decreases flow which leads to distal ischemia

Embolization leads to blockage of an artery which leads to distal ischemia

Palpation

Most arteries can be palpated by placing two fingers over the artery

Pedal pulses are evaluated in lower extremity

Distal Ao, femoral and pop arteries can also be palpated, NOT pero

Radial and ulnar arteries are palpated to eval upper extremity pulses

Pulses are described as:

0 none

1+ weak

2+ good

3+ strong

4+ bounding

Auscultation

Place a stethoscope over the Ao at the level of the inguinal ligament to identify a possible bruit

Ask pt to hold their breath

Stenosis at the iliac artery and CFA can cause a buit

Bruits are described as:

1+ mild

2+ moderate

3+ severe

>90% stenosis does NOT cause a

Bruit

Signs and symptoms of arterial disease

Pallor: paleness of skin due to deficient blood supply; if you eval leg and pallor occurs, significant arterial disease is present

Dependent Rubor: Pt supine, skin pale, pt sits with legs dependent, skin reddens with increased flow

Cyanosis: Bluish discoloration due to concentration of DeO2 hemoglobin

Gangrene: necrotic tissue due to arterial ischemia/obstruction; venous gangrene usually involves the foot and all toes, while arterial gangrene usually involves one or two toes

Reduced or absent pedal pulses, Thrill, Bruit, Claudication and pseudoclaudication, Blue toe syndrome, ulcerations, cool temperature, delayed capillary blush response

Rest pain: burning pain in calf, ball of foot and toes that is worse at night when the pt is sleeping

Sites to asses for bruit

CCA → MOST COMMON

Aorta

Femoral artery

Pop A

Causes of thrill

Post-stenotic turbulence

AV fistula

Patent hemodialysis graft

Most common symptom of PAD

Claudication

Claudication

Pain in muscles that subsides with rest

Pain will be predictable and reproducible by the same level of exercise

Pain occurs DISTAL to obstruction

Caused by muscular ischemia

Most common sites: Buttock aortoiliac disease, thick iliac or femoral occlusive disease, calf-femoro-popliteal disease

6 P’s of Acute Arterial occlusion

Pain

Pallor

Pulselessness

Paresthesia - numbness/tingling

Paralysis

Polar sensation - cold

Acute arterial occlusion

Caused by embolism, thrombus formation or trauma

Considered a critical finding due to lack of collateral formation with acute obstruction

Permanent injury to the leg or loss of the leg can occur without immediate intervention

Treatment can include administration of urokinase or streptokinase for the lytic properties

What calf vessel is palpated the most in pts

PTA

What are common causes of a bruit in the groin

Pseudo, stenosis of the CFA and Iliac artery

What does the capillary blush test eval for?

Ischemic disease

Venous gangrene typically involves _______, while arterial gangrene typically involves _______

The entire foot and ankle; The tips of the toes

What is a normal cause of thrill over and artery

Dialysis fistula

What are key characteristics of true claudication

Calf pain that is reproducible and predictable with consistent duration of exercise

Which of the following is a characteristic of a skin ulcer caused by peripheral arterial disease?

Oozing

Weeping
Crusty

Minimal pain

Crusty

Feeling of pins and needles in an extremity is called:

Paresthesia