Term
What causes LEAD
Describe progression |
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Definition
LEAD is caused by atherosclerosis
Progressive plaque formation leads to stenosis, which leads to ischemia |
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Term
Note re: LEAD recognition and diagnosis
Problem re: presentation
Clinical priority |
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Definition
40-50% is unrecognized and undiagnosed
People are not aware that LEAD exists until the disease has progressed to its final stages resulting in pain, functional impairment, gangrene and amputation
Clinical priority is aimed at reducing risk and delaying progression of atheroslcerosis |
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Term
LEAD as a marker
LEAD and CAD
LEAD and CVA |
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Definition
LEAD is a marker of systemic atherosclerosis
70-90% with LEAD have CAD
>/=50% have cerebrovascular disease |
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Term
| Other conditions that cause impaired arterial circulation |
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Definition
Raynaud's disease
Buerger's disease
Carotid artery disease
Aortic aneurysm |
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Term
Describe how Raynaud's disease works
Describe how Buerger's disease works
Main symptoms of Buergers |
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Definition
Idiopathic. Stress and cold trigger vasospasm in hands, causing necrosis of distal parts.
Pain in the affected areas, ulcerations, gangrene in extremities that may require amputation
Chronic clotting disease caused by tobacco |
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Term
Describe carotid artery disease
Presentation |
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Definition
Atherosclerosis results in plaque build up resulting in decreased blood to brain or embolus that obstructs circulation to the brain or within the brain
Confusion, loss of vision, aphasia, hemiplegia, loss of balance, sudden severe HA |
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Term
Etiology of aortic aneurysm
Patho
Presentation
Possible complication |
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Definition
Underlying weakness of aortic wall
HTN, atherosclerosis weakens wall of aorta resulting in enlargement and rupture
Asymptomatic. Abdominal, chest, back discomfort. Impingement of nerve roots may result in leg pain or numbness. Rupture may result in severe radiating pain from abdomen to back.
Clots may infarct bowel, causing stroke |
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Term
| 5 modifiable risk factors for LEAD |
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Definition
Smoking
HTN
High serum cholesterol
Overweight
Physical inactivity |
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Term
| 6 non-modifiable risk factors for LEAD |
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Definition
Age >70
50-69 w/ hx of smoking or DM
<50 w/ DM and other atherosclerotic risk factor
DM
Family hx of LEAD, CVD, MI, CVA
Af-Am |
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Term
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Definition
Asymptomatic
Intermittent claudication
Ischemic rest pain
Ulceration and gangrene |
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Term
Describe intermittent claudication
How it may be evaluated
Describe ischemic rest pain
Seriousness note re: ischemic rest pain |
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Definition
Pts may report fatigue, heaviness, fatigue, cramping of muscles in butt/ thighs/ calf that occurs w/ activity or exertion and is relieved w/ rest
Is reproducible, can eval this way
Pain in leg, foot or toes at rest (means it's really bad)
Pain on elevation relieved by dependent position
Suggests >90% stenosis |
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Term
| Sleep problem with LEAD pts |
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Definition
| Pain comes with laying down, so may not want to |
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Term
LEAD presentation:
Muscle
Skin appearance
Temperature
Rubor/pallor
Rubor elevation note |
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Definition
Often muscle atrophy in affected extremity
Pale, shiny skin with hair loss
Skin is cool to touch
Dependent rubor, pallor on elevation
If you elevate the leg and rubor disappears, is dependent; if it does not, possible cellulitis |
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Term
Acute arterial occlusion:
Symptom onset
Description of presentation
What causes
Seriousness |
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Definition
Sudden onset of symptoms
Rapid decrease in perfusion with sudden onset of pain, pallor, paresthesia, paralysis, pulselessness, polar (cool extremity)
Caused by embolism or thrombus
Limb threatening; requires referral to vascular surgery |
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Term
When can do ABI on LEAD
When to do TBI
Referral note |
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Definition
Do on pts suspected of LE PAD (eg intermittent claudication, non-healing wound, etc)
Perform TBI on pts w/ ABI of >1.4
If TBI is <.6 or toe pressure cannot be detected with Doppler, refer to vascular |
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Term
What is TCPO2? (in LEAD)
Two readings and what they mean |
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Definition
Transcutaneous oxygen measures assess tissue perfusion
<40 mmHg= hypoxia
<20 mmHg= assoc w/ failure to heal after amputation |
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Term
ABI results in lead: readings and symptomology for:
Normal
Borderline
Abnormal
Severe ischemia
Critical ischemia
Noncompressible |
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Definition
Normal: 1-1.4: normal
Borderline: .91-.99: asymptomatic
Abnormal: .90 or less: likely symptomatic
Severe ischemia:
Critical ischemia:
Noncompressible: >1.4: calcification |
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Term
| 3 diagnostic tests used in LEAD |
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Definition
Duplex US
CT angio
MR angio |
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Term
| What duplex US does for LEAD pt |
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Definition
| Diagnoses anatomic location and degree of stenosis in PAD and predicts ideal access for intervention |
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Term
| Use of ABI in LEVD vs LEAD |
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Definition
| In LEVD, ABI is used to r/o arterial disease. In LEAD, is used to determine extent of occlusion |
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Term
| 5 meds used in LEAD, with note for last |
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Definition
Statins
ACEI
ASA
Plavix
Cilostazol: used w/ walking, increases walking distance |
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Term
LEAD management:
BP goal
Lipid goals
Physical activity goals
DM control |
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Definition
BP <130/85 in people w/ DM and CKD
LDL <100 without evidence of CVD
<70 w/ evidence of CVD
30 min 3X/wk X12 wks
A1C <7 |
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Term
3 places arterial ulcers found
How does lesion appear |
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Definition
Tips of toes/b/w toes
Bony prominences
Sites exposed to minor trauma (mid tibia, lateral malleolus, foot dorsum)
Edges well defined with a punched out appearance |
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Term
Arterial ulcer color
Arterial ulcer tissue
Exudate
Surrounding skin |
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Definition
Pale, gray and nonviable
Minimal granulation; dessication and necrosis
Minimal drainage
Erythema |
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Term
Note re: stable eschar
How to tx
When to maintain
When to refer to vascular surgery
What will happen if gets wet |
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Definition
Do not debride dry stable eschar until perfusion has been assessed
If dry, non draining, no signs of infection: keep dry, relieve pressure and protect
Maintain dry stable eschar if blood flow is inadequate for healing
ABI <0.5
If get wet, starts autolytic debridement, which can erode and go down to bone |
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Term
| 4 ways to debride soft eschar |
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Definition
Mechanical debridement w/ antiseptic soln
Enzymatic debridement
Hydrogel dsg
Antibacterial dsg |
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Term
3 causes for LEAD vascular surgery referral
1 cause for urgent vascular referral |
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Definition
***Absence of dorsalis pedis and posterior tibial pusles
***ABI <0.9 with specific indications
***ABI <0.5
ABI <0.4 or presence of gangrene |
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Term
Indications for vascular surgery referral for those w/ ABI <0.9:
Wound healin
2 re: pain
Two pressures
Scary sign |
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Definition
Wounds failing to improve w/in 2-4 wks of appropriate therapy
Severe ischemic pain
Intermittent claudication
Toe pressure <30
Ankle pressure <50
Clinical signs of infection |
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Term
Bypass/angioplastic in LEAD:
What provides
When indicated
When not indicated |
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Definition
Short term relief of claudication
Indicated for significant functional impairment
Not indicated for pts w/ decreased limb perfusion (ABI <0.4) |
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Term
| 4 indications for amputation in LEAD |
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Definition
Significant necrosis on wt bearing portions of feet
Uncorrectable flexion contractures
Ischemic pain
Sepsis |
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