Peripheral Arterial Disease of the Lower Extremities

Peripheral Arterial Disease of the Lower Extremities

DescriptionDescription

PAD may affect Aortoiliac artery Femoral artery Popliteal artery Tibial artery Peroneal artery

PAD may affect Aortoiliac artery Femoral artery Popliteal artery Tibial artery Peroneal artery

Clinical ManifestationsClinical Manifestations

Classic symptom of PAD Intermittent claudication

Ischemic muscle ache or pain that is precipitated by a constant level of exercise


Ischemic muscle ache or pain that is precipitated by a constant level of exercise



Resolves within 10 minutes or less with rest

Reproducible


Resolves within 10 minutes or less with rest

Reproducible


Paresthesia Thin, shiny, and taut skin Loss of hair on the lower legs Diminished/absent pedal,

popliteal, or femoral pulses

Paresthesia Thin, shiny, and taut skin Loss of hair on the lower legs Diminished/absent pedal,

popliteal, or femoral pulses


Pallor Reactive hyperemia

Pallor Reactive hyperemia


Rest pain Occurs in the forefoot or toes

and is aggravated by limb elevation

Occurs from insufficient blood flow

Occurs more often at night

Rest pain Occurs in the forefoot or toes

and is aggravated by limb elevation

Occurs from insufficient blood flow

Occurs more often at night

ComplicationsComplications

Atrophy of the skin and underlying muscles

Delayed healing Wound infection Tissue necrosis Arterial ulcers

Atrophy of the skin and underlying muscles

Delayed healing Wound infection Tissue necrosis Arterial ulcers

Diagnostic StudiesDiagnostic Studies

Doppler ultrasound Segmental blood pressures

Ankle-brachial index (ABI) Done using a handheld Doppler

Duplex imaging

Doppler ultrasound Segmental blood pressures

Ankle-brachial index (ABI) Done using a handheld Doppler

Duplex imaging

Diagnostic StudiesDiagnostic Studies

Angiogram Magnetic resonance angiography

(MRA) Health and physical examination

Include palpation of peripheral pulses

Angiogram Magnetic resonance angiography

(MRA) Health and physical examination

Include palpation of peripheral pulses

Collaborative CareRisk Factor ModificationCollaborative CareRisk Factor Modification

Smoking cessation Aggressive treatment of

hyperlipidemia Hypertension and diabetes

mellitus BP maintained < 130/85 Glycosylated hemoglobin < 7.0%

for diabetics

Smoking cessation Aggressive treatment of

hyperlipidemia Hypertension and diabetes

mellitus BP maintained < 130/85 Glycosylated hemoglobin < 7.0%

for diabetics

Collaborative CareDrug TherapyCollaborative CareDrug Therapy

Antiplatelet agents aspirin ticlopidine (Ticlid) clopidogrel (Plavix)

Antiplatelet agents aspirin ticlopidine (Ticlid) clopidogrel (Plavix)

Collaborative CareDrug TherapyCollaborative CareDrug Therapy

Drugs prescribed for treatment of intermittent claudication pentoxifylline (Trental) heparin cilostazol (Pletal)

Drugs prescribed for treatment of intermittent claudication pentoxifylline (Trental) heparin cilostazol (Pletal)

Collaborative CareExercise TherapyCollaborative CareExercise Therapy

Exercise improves oxygen extraction in the legs and skeletal metabolism

Walking is the most effective exercise for individuals with claudication 30 to 40 minutes/day

Exercise improves oxygen extraction in the legs and skeletal metabolism

Walking is the most effective exercise for individuals with claudication 30 to 40 minutes/day

Collaborative CareNutritional TherapyCollaborative CareNutritional Therapy

Dietary cholesterol less than 200 mg/day

Decrease intake of saturated fat Soy products can be used in

place of animal protein

Dietary cholesterol less than 200 mg/day

Decrease intake of saturated fat Soy products can be used in

place of animal protein

Collaborative CareComplementary/Alternative Therapies

Collaborative CareComplementary/Alternative Therapies

Ginkgo biloba Effective in increasing walking

distance for patients with intermittent claudication

Folate, vitamin B6, cobalamin (B12) Lowers homocysteine levels

Ginkgo biloba Effective in increasing walking

distance for patients with intermittent claudication

Folate, vitamin B6, cobalamin (B12) Lowers homocysteine levels

Collaborative CareCare of the Leg with Critical Limb Ischemia

Collaborative CareCare of the Leg with Critical Limb Ischemia

Protect from trauma Decrease vasospasm Prevent/control infection Maximize arterial perfusion

Protect from trauma Decrease vasospasm Prevent/control infection Maximize arterial perfusion

Collaborative CareInterventional Radiologic Procedures


Indications Intermittent claudication

symptoms become incapacitating

Pain at rest Ulceration or gangrene severe

enough to threaten viability of the limb

Indications Intermittent claudication

symptoms become incapacitating

Pain at rest Ulceration or gangrene severe

enough to threaten viability of the limb



Percutaneous transluminal balloon angioplasty Involves the insertion of a

catheter through the femoral artery

Catheter contains a cylindric balloon

Percutaneous transluminal balloon angioplasty Involves the insertion of a

catheter through the femoral artery

Catheter contains a cylindric balloon



Percutaneous transluminal balloon angioplasty Balloon is inflated dilating the

vessel by cracking the confining atherosclerotic intimal shell

Percutaneous transluminal balloon angioplasty Balloon is inflated dilating the

vessel by cracking the confining atherosclerotic intimal shell

Collaborative CareSurgical TherapyCollaborative CareSurgical Therapy

Most common surgical approach A peripheral arterial bypass

operation with autogenous vein or synthetic graft material to bypass blood around the lesion

Most common surgical approach A peripheral arterial bypass

operation with autogenous vein or synthetic graft material to bypass blood around the lesion

Collaborative CareSurgical TherapyCollaborative CareSurgical Therapy

Endarterectomy Patch graft angioplasty Amputation

Endarterectomy Patch graft angioplasty Amputation

Nursing ManagementNursing AssessmentNursing ManagementNursing Assessment

Past Health History Diabetes mellitus Smoking Hypertension Hyperlipidemia Obesity

Past Health History Diabetes mellitus Smoking Hypertension Hyperlipidemia Obesity

Nursing ManagementNursing AssessmentNursing ManagementNursing Assessment

Exercise intolerance Loss of hair on legs and feet Decreased or absent peripheral

pulses

Exercise intolerance Loss of hair on legs and feet Decreased or absent peripheral

pulses

Nursing ManagementNursing DiagnosesNursing ManagementNursing Diagnoses

Ineffective tissue perfusion (peripheral)

Impaired skin integrity Acute pain Activity intolerance Ineffective therapeutic regimen

management

Ineffective tissue perfusion (peripheral)

Impaired skin integrity Acute pain Activity intolerance Ineffective therapeutic regimen

management

Peripheral Arterial Disease of the Lower Extremities

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