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Peripheral Vasculature Diseases – Section 2 OCCLUSIVE ARTERIAL DISEASES

  • These diseases may be caused by atherosclerosis, thromboembolism, or vasculitis (inflammation of the vessel wall).

  • Clinical presentation of occlusive arterial diseases results from decreased blood flow to the affected limbs or organs.

This section will summarize: 1/ Peripheral Arterial Disease 2/ Acute Arterial Occlusion 3/ Vasculitic Syndromes (four of these)

Peripheral Arterial Disease (PAD) Clinical Presentation:

  • Claudication: symptom of exertional limb fatigue and pain

    • o

      Patients with PAD often report discomfort of buttock, thigh, or calf that is precipitated by walking and relieved with rest.

  • Severe PAD patient may report pain at rest in the feet or toes.

  • Can have ulceration, infection, skin necrosis, and even gangrene (threatening viability of a limb).

Physical Findings:

  • Loss of pulses distal to the stenotic segment

  • Bruits (swishing sounds that indicates turbulent blood flow) may be audible in abdomen (renal or mesenteric arteries) or over iliac, femoral, or subclavian arterial stenoses.

  • Can see muscle atrophy, pallor, cyanotic discoloration, hair loss, occasional gangrene and necrosis of foot/digits.

  • Ischemic ulcers start as small traumatic wounds on tips of toes or lateral malleolus – as opposed to diabetic ulcers, which are found more proximally and on the medial malleolus.

  • Compare blood pressure measure from ankle to BP measure from arm – called Ankle-Brachial Index (ABI).

    • o

      Use BP cuff and a Doppler instrument to detect blood flow

      • o

        Normal: ABI (ankleBP/armBP) 1.0

      • o

        Claudication: ABI < 0.9

      • o

        Patient with pain at rest and severe arterial compromise: ABI < 0.5

Etiology:

  • PAD may result from atherosclerotic plaques in large and medium size arteries.

  • PAD is most prevalent vascular disorder – 0.3% of total population, 5.2% of population over age 70

  • Risk factors: smoking, dyslipidemia, diabetes mellitus, hypertension

  • 40% of patients with symptomatic PAD also have significant coronary artery disease

Pathology:

  • Generally, atherosclerotic disease in arteries of pelvis or lower limbs

  • Identical pathology to that of atherosclerotic coronary artery disease (CAD)

  • have progressive stenosis and obstruction of blood flow

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