Podcast
Questions and Answers
Which of the following is NOT a cause of stenosis in peripheral arterial disease (PAD)?
Which of the following is NOT a cause of stenosis in peripheral arterial disease (PAD)?
What percentage of blockage in arteries usually manifests clinical symptoms of peripheral arterial disease?
What percentage of blockage in arteries usually manifests clinical symptoms of peripheral arterial disease?
Which of the following factors is a leading cause of peripheral arterial disease?
Which of the following factors is a leading cause of peripheral arterial disease?
What is likely to happen as peripheral arteries narrow due to conditions like PAD?
What is likely to happen as peripheral arteries narrow due to conditions like PAD?
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Which of the following statements best describes peripheral venous disease compared to peripheral arterial disease?
Which of the following statements best describes peripheral venous disease compared to peripheral arterial disease?
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What condition results from the narrowing of peripheral arteries due to atherosclerosis, leading to reduced blood flow to the extremities?
What condition results from the narrowing of peripheral arteries due to atherosclerosis, leading to reduced blood flow to the extremities?
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Which of the following best describes the clinical presentation of ischemia due to peripheral arterial disease?
Which of the following best describes the clinical presentation of ischemia due to peripheral arterial disease?
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Which risk factor is not traditionally associated with the development of peripheral arterial disease?
Which risk factor is not traditionally associated with the development of peripheral arterial disease?
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How does atherosclerosis contribute to peripheral arterial disease?
How does atherosclerosis contribute to peripheral arterial disease?
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Which statement best describes the expected demographic trend regarding peripheral arterial disease in Canada?
Which statement best describes the expected demographic trend regarding peripheral arterial disease in Canada?
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What characterizes the primary underlying issue in peripheral arterial disease (PAD)?
What characterizes the primary underlying issue in peripheral arterial disease (PAD)?
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Which is a significant consequence of less oxygen-rich blood reaching the periphery in PAD?
Which is a significant consequence of less oxygen-rich blood reaching the periphery in PAD?
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What structural change in arterial walls is primarily associated with the development of atherosclerosis?
What structural change in arterial walls is primarily associated with the development of atherosclerosis?
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Which risk factor is considered critical in the rising prevalence of PAD among Canadians over 50?
Which risk factor is considered critical in the rising prevalence of PAD among Canadians over 50?
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How does chronic ischemia related to PAD primarily manifest in affected extremities?
How does chronic ischemia related to PAD primarily manifest in affected extremities?
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What typical event usually triggers clinical symptoms of PAD?
What typical event usually triggers clinical symptoms of PAD?
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Which lifestyle choice is recognized as a modifiable risk factor for developing PAD?
Which lifestyle choice is recognized as a modifiable risk factor for developing PAD?
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Which biological process primarily leads to the narrowing of arteries in PAD?
Which biological process primarily leads to the narrowing of arteries in PAD?
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What condition commonly exacerbates the risk of developing peripheral vascular disease as the population ages?
What condition commonly exacerbates the risk of developing peripheral vascular disease as the population ages?
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What is the primary mechanism by which atherosclerosis contributes to arterial narrowing in peripheral arterial disease?
What is the primary mechanism by which atherosclerosis contributes to arterial narrowing in peripheral arterial disease?
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Which demographic is most likely to be affected by peripheral arterial disease based on the provided information?
Which demographic is most likely to be affected by peripheral arterial disease based on the provided information?
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What is a significant potential consequence of ischemia due to peripheral arterial disease?
What is a significant potential consequence of ischemia due to peripheral arterial disease?
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Which factors are most critically associated with the rising prevalence of peripheral arterial disease?
Which factors are most critically associated with the rising prevalence of peripheral arterial disease?
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What happens to blood flow when arteries become narrowed due to conditions like atherosclerosis?
What happens to blood flow when arteries become narrowed due to conditions like atherosclerosis?
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Which of the following conditions is most commonly a consequence of peripheral arterial disease?
Which of the following conditions is most commonly a consequence of peripheral arterial disease?
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What structural change in arteries primarily characterizes atherosclerosis?
What structural change in arteries primarily characterizes atherosclerosis?
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Which of the following statements about peripheral venous disease compared to peripheral arterial disease is accurate?
Which of the following statements about peripheral venous disease compared to peripheral arterial disease is accurate?
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Which risk factor is not typically associated with peripheral arterial disease?
Which risk factor is not typically associated with peripheral arterial disease?
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Study Notes
Perfusion
- Arteries carry blood away from the heart
- Veins return blood to the heart
Peripheral Vascular Disease (PVD)
- Includes Peripheral Venous Disease (PVD) and Peripheral Arterial Disease (PAD)
- PAD is a narrowing of peripheral arteries.
- 1 in 20 Canadians over 50 have PAD.
- Atherosclerosis is a major cause of PAD.
- PVD can also be described as Peripheral Venous Insufficiency (PVI) or Chronic Venous Insufficiency (CVI).
- 20% of people with PVD also suffer from PAD.
Pathophysiology of PAD
- PAD = narrowing of peripheral arteries
- Causes of PAD
- Atherosclerosis (thickening, loss of elasticity, and calcification of arterial walls)
- Inflammation
- Thromboembolism
- Thrombosis
- Narrowing of the arteries decreases the amount of oxygen-rich blood reaching the extremities, causing ischemia.
Atherosclerosis
- Accumulation of fat, fibrin, and other substances within artery walls.
- Hards the arteries and reduces blood flow.
- Clinical symptoms appear when 60-75% of the artery is blocked.
- Leading cause of PAD
Risk Factors for PAD
- Smoking
- Diabetes
- High cholesterol
- Hypertension (HTN)
- Obesity
- Age
- Sedentary lifestyle
- Stress
- History of deep vein thrombosis (DVT)
- Female gender
- Multigravida pregnancy
- Prolonged standing/sitting
Symptoms of PAD
- Absent pulses (cool, shiny, no hair)
- Round, red sores on toes/feet
- Pale or blackened toes and feet
- Intermittent claudication (sharp calf pain)
- 6 Ps of PAD assessment findings
- Pain (including intermittent claudication and pain with legs elevated)
- Pallor
- Pulses
- Paresthesia
- Polar (cold)
- Paralysis (severe side effect from deoxygenation)
Intermittent Claudication
- Calf pain triggered by exercise.
- Pain resolves with rest.
- Affects 10% of PAD patients.
- Can also occur in the buttock, foot, or thigh.
Critical Limb Ischemia
- Severe manifestation of PAD lasting longer than 2 weeks.
- Non-healing wounds or gangrene
- High risk of amputation, cardiovascular complications (CV) and mortality
- ABI (<0.4) and toe systolic pressure (<30mmHg) indicate this condition
- 93% of VLU heal within 12 months
- 7% of VLU heal within 5 years
- 70% reoccurrence rate within 3 months
Dry Gangrene
- Wounds kept dry, clean, and disinfected.
- Amputation and antibiotics may be necessary to stop spreading.
PAD Diagnositcs
- ABI testing: Ankle-brachial index assesses blood pressure at the ankle and arm to detect arterial blockages.
- Values >1.4 indicate calcification and vessel hardening. Referral to a vascular specialist is needed.
- Values between 1.0-1.4 are normal.
- Values between 0.9-1.0 are acceptable and may require monitoring of risk factors.
- Values between 0.8-0.9 indicates some arterial disease and require risk factor management.
- Values between 0.5-0.8 indicate moderate arterial disease and require referral and may require treatment.
- Values less than 0.5 indicates severe arterial disease and require urgent referral for treatment.
- Duplex ultrasound: Used to evaluate blood flow and blood clots.
- Rutherford and Fontaine stages: Provide detailed descriptions and categories based on the severity of PAD from asymptomatic to gangrene.
Peripheral Arterial Disease and Ankle-Brachial Index
- ABI: A sensitive and specific metric for diagnosing PAD that helps predict mortality and cardiovascular events.
- Guidelines recommend measuring ABI in smokers over 50, diabetics over 50, and patients over age 70.
- Measuring ABI involves determining systolic pressure at the ankle to compare with the systolic pressure at the arm.
Peripheral Venous Disease (PVD)
- Blood pooling in the extremities as blood cannot return to the heart.
- Can be caused by incompetent valves or narrowed veins.
- Symptoms
- Very big pulses/warm legs
- Edema (blood pooling)
- Irregularly shaped sores
- Brownish-yellow discoloration
- Risk factors
- History of DVT
- Female gender
- Multigravida pregnancy
- Standing/sitting for prolonged periods
- Obesity
- Varicose veins
- Smoking
- Treatment includes elevating veins, compression, exercise, smoking cessation, weight management, vein stripping (removal of varicose veins), and medication (Plavix, statins)
- Diagnosis includes ultrasound (to rule out DVT) and ABI.
Aneurysms
- Weakening of a blood vessel wall causing widening or ballooning.
- Can be true (fusiform, saccular) or false (pseudo)
- A true aneurysm affects all layers of the vessel
- A fusiform aneurysm is uniform with symmetrical dilation
- A saccular aneurysm is localized with an outpouching affecting only part of the vessel wall.
- A false aneurysm is a clotted collection of blood outside of the blood vessel.
Aortic Aneurysm
- Typically affects the abdominal aorta, making up 75% of cases.
- Thoracic aortic aneurysms account for 25%.
- Risk Factors: Infection, genetic, sex, age, CAD/PAD, hypertension (HTN), high cholesterol, family history, blunt force trauma, atherosclerosis, smoking.
Aneurysm Symptoms
-
Abdominal Aortic Aneurysm (AAA):
- Frequently asymptomatic
- Back pain, epigastric discomfort, gnawing pain in abdomen as the aneurysm enlarges
- Assessment findings - systolic bruit over aorta, tenderness on palpation, pulsatile mass in periumbilical area left of midline (caution with palpation), Grey Turner's and Cullen's signs (may appear with rupture).
-
Thoracic Aortic Aneurysm:
- Angina, TIA, hoarseness, cough, shortness of breath (SOB), swallowing difficulties, jugular venous distension and edema on the face, pressure on superior vena cava.
Aneurysm Risks
- Rupture: Risk of shock, hemorrhage
- Clots: Can occlude vessels or block smaller vessels, especially with saccular aneurysms.
- Compression: May compress other structures or organs.
Aneurysm Diagnostic Tests
- Radiography
- Ultrasound
- CT scans
- MRI
Rupture of an Aneurysm (Classic Signs)
- Severe pain
- Hypotension
- Pulsatile mass
Grey Turner's & Cullen's Signs
- Indicators of potential internal bleeding.
Nursing Care for Aneurysms
- Frequent vital signs
- Detailed history, including abdominal pain
- Monitor peripheral circulation (pulse, temp, color)
- Continuous cardiac monitoring
- Arterial blood gases
- Hourly urine output
- Observe for signs of rupture
- Pay attention to pain level and tenderness over abdomen
- Monitor for abdominal distension
- Frequent HCP visits for monitoring.
Aneurysm Interventions
- Modifying risk factors, such as blood pressure with antihypertensives.
- Regular healthcare provider visits to monitor aneurysm size (every 6-12 months).
- Teaching patients to report back pain, abdominal pain, fullness, soreness over the umbilicus, and sudden discoloration of extremities.
- Monitoring and treatment of blood pressure with antihypertensives.
- Will be on antihypertensives for life
Aortic Aneurysm Surgical Repair
- Open repair: The abdomen is opened, the diseased portion of the aorta is removed and replaced with a graft, which is stitched in place.
- Endovascular repair (EVAR): A catheter is inserted via the femoral artery with a stent on the tip to reach the targeted diseased area.
Peripheral Vascular Disease (PVD) Treatment
- Dangle legs
- Daily skin care and moisturizing
- Smoking cessation
- Hydration to avoid hypovolemia
- Nail care (by trained medical professional)
- Medications (Vasodilators, Antiplatelets, Statins)
- Patient teaching regarding caution of hot temperatures, foot trauma, constriction clothing, and cigarettes.
- Compression is important (10-15mmHg, 20-30mmHg, 30-40mmHg).
- Appropriate use of compression garments.
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Description
Test your knowledge on peripheral arterial disease (PAD) with this quiz. Explore the causes, symptoms, and differences between PAD and venous diseases. Enhance your understanding of the circulatory system and its disorders.
