logging in or signing up Peripheral Arterial Disease aSGuest43460 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Copy Does not support media & animations WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 1818 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: April 25, 2010 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript Peripheral Arterial Disease : Peripheral Arterial Disease Rebecca Herlitz, ACNP-BC Peripheral Arterial Disease : Peripheral Arterial Disease Spectrum from intermittent claudication to critical limb ischemia Incidence of up to 20% of the population over the age of 55 Intermittent claudication is most common manifestation Mortality : Mortality Mortality in patients with claudication is 2-3 times higher than their peers. 5 year mortality is 40% if patient has symptomatic coronary or cerebral disease 75% of patients with PAD die from coronary event or stroke Pathophysiology : Pathophysiology Atherosclerosis is most common cause of arterial insufficiency Poor arterial flow results in ischemia and eventually can lead to ulcers and tissue loss Other causes include: Vasospastic diseases such as Raynaud’s syndrome Vasculitis such as rheumatoid disease Acute ischemia is usually an embolic event Signs and Symptoms : Signs and Symptoms Claudication: pain that develops with exercise and goes away with rest Typically cramping pain when walking in calf, thigh, or buttock Pain generally absent when at rest, starts at a reproducible distance such as 1-2 blocks Claudication : Claudication Typically cramping pain when walking in calf, thigh, or buttock Pain generally absent when at rest, starts at a reproducible distance such as 1-2 blocks Other conditions can mimic this pain such as spinal stenosis and degenerative hip disease Physical exam is important to help differentiate Claudication : Claudication Blockages in aorta and iliacs cause pain in buttock, hips, and thighs Femoral artery blockage causes pain in thigh and calf Popliteal blockage causes pain in calf or ankle Critical Limb IschemiaWhen to Refer : Critical Limb IschemiaWhen to Refer Rest pain Tissue loss Ulceration Sudden onset of pain, pulselessness, palor, paresthesia, or cold limb indicating an acute event Signs : Signs Physical Assessment : Physical Assessment Femoral pulses: check above the inguinal fold Popliteal pulse is behind the knee Doralis Pedis is on the top of the foot and the posterior tibial pulse in on the medial aspect of the ankle Anatomy : Anatomy Medical Management : Medical Management Smoking cessation Lipid management with statins Exercise program BP management Antiplatelet: Aspirin or Plavix Walking Program : Walking Program Have patients start walking program if medically able. They should walk until near maximal pain then stop to rest until pain subsides. Goal is 30 minutes walking most days of the week. This stimulates collateral circulation Summary : Summary Patients experiencing stable claudication often improve with good medical management Signs of critical limb ischemia should be referred for urgent evaluation Walking program can be as effective as angioplasty in improving maximal walking distance Resources : Resources Vascular Web http://www.vascularweb.org/patients/NorthPoint/Leg_Artery_Disease.html Hankey, G.J., Norman, P.E., & Eikelboom, J.W. (2006). Medical management of peripheral arterial disease. JAMA, 295(5):547-553 You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.