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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
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).
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).
Use BP cuff and a Doppler instrument to detect blood flow
Normal: ABI (ankleBP/armBP) ≥ 1.0
Claudication: ABI < 0.9
Patient with pain at rest and severe arterial compromise: ABI < 0.5
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
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