• PERIPHERAL ARTERY STUDY GUIDE ASSURED SUCCEED COMBINED
WITH Q&A Peripheral Artery disease (PAD)
I. Thickening of the artery walls, a progressive narrowing of the arteries in the upper
and lower extremities
II. Typically, people become symptomatic in their 60s-70s
III. Strongly related to other types of CVD
IV. The leading cause is atherosclerosis
• Risk factors:
I. Tobacco (the biggest risk factor)
II. Diabetes
III. HTN
IV. High cholesterol
V. Chronic kidney disease
• Clinical manifestations:
• Intermittent claudication:
I. This is the classic symptom reported by 1/3 of patients with PAD
(the remaining have no symptoms)
II. Ischemic muscle pain that is caused by exercise, resolves within 10
minutes or less with rest and is reproducible
III. Ischemic pain is a result of lactic acid buildup
IV. PAD in the iliac arteries causes claudication in the buttocks and thighs
V. Calf claudication indicates femoral or popliteal artery
• Paresthesia (numbness or tingling) in the toes or feet
, • Skin thin, shiny, taut
• Hair loss over the lower legs
• Diminished or absent pedal, femoral, or popliteal pulses
• Critical limb ischemia- chronic ischemic rest pain lasting more than 2 weeks,
arterial leg ulcers, or gangrene of the leg as a result of PAD
• Complications:
I. Minor trauma can lead to delayed healing, wound infection, and tissue necrosis
II. Non-healing arterial ulcers, and gangrene may lead to amputation
• Diagnostic Studies:
• Doppler ultrasound with duplex imaging
• Segmental blood pressure at the thigh, below the knee, and at the ankle level
• Ankle-Brachial Index screening tool and ABI >0.7 is considered mild PAD.
• Interprofessional Care:
• Table 37-2
• Goals:
• Adequate tissue perfusion
• Relief of pain
• Increased exercise tolerance
• Intact, healthy skin on the extremities
• Increased knowledge of the disease and treatment plan
• Risk factor modification:
• Lifestyle mods (DM, HTN, smoking)
• Diet-reduce sodium, do a DASH diet (dietary approaches to stop
hypertension) and reduce BMI. Decrease cholesterol, saturated fats, and
sugars
, • Medications:
• ACE inhibitors
• Antiplatelet (ASA clopidigrel)
• Watch clopidogrel when used with omeprazole-increases risk
of MI and stroke
• Anticoagulants (Warfarin)
• Care of the leg with Limb Ischemia:
• Basic care and comfort:
• Carefully inspect, cleanse, and lubricate feet to prevent skin irritation
• Do not lubricate between the toes! (prevents breakdown)
• Cover ulcers with a dry, sterile dressing
• Wound care
• Encourage soft, roomy protective footwear
• Wear clean, all-cotton or all-wool socks and soft insoles
• Tie shoes loosely
• Keep heels free of pressure
• Surgical:
• PTA
• Peripheral artery bypass
• Endarterectomy
• Amputation
• Post-surgical or radiologic care:
• Check operative extremity every 15 minutes initially, then hourly.
• Assess color, temperature, capillary refill, presence of
peripheral pulses, and sensation and movement
• Loss of palpable pulses or change in Doppler sound over a
WITH Q&A Peripheral Artery disease (PAD)
I. Thickening of the artery walls, a progressive narrowing of the arteries in the upper
and lower extremities
II. Typically, people become symptomatic in their 60s-70s
III. Strongly related to other types of CVD
IV. The leading cause is atherosclerosis
• Risk factors:
I. Tobacco (the biggest risk factor)
II. Diabetes
III. HTN
IV. High cholesterol
V. Chronic kidney disease
• Clinical manifestations:
• Intermittent claudication:
I. This is the classic symptom reported by 1/3 of patients with PAD
(the remaining have no symptoms)
II. Ischemic muscle pain that is caused by exercise, resolves within 10
minutes or less with rest and is reproducible
III. Ischemic pain is a result of lactic acid buildup
IV. PAD in the iliac arteries causes claudication in the buttocks and thighs
V. Calf claudication indicates femoral or popliteal artery
• Paresthesia (numbness or tingling) in the toes or feet
, • Skin thin, shiny, taut
• Hair loss over the lower legs
• Diminished or absent pedal, femoral, or popliteal pulses
• Critical limb ischemia- chronic ischemic rest pain lasting more than 2 weeks,
arterial leg ulcers, or gangrene of the leg as a result of PAD
• Complications:
I. Minor trauma can lead to delayed healing, wound infection, and tissue necrosis
II. Non-healing arterial ulcers, and gangrene may lead to amputation
• Diagnostic Studies:
• Doppler ultrasound with duplex imaging
• Segmental blood pressure at the thigh, below the knee, and at the ankle level
• Ankle-Brachial Index screening tool and ABI >0.7 is considered mild PAD.
• Interprofessional Care:
• Table 37-2
• Goals:
• Adequate tissue perfusion
• Relief of pain
• Increased exercise tolerance
• Intact, healthy skin on the extremities
• Increased knowledge of the disease and treatment plan
• Risk factor modification:
• Lifestyle mods (DM, HTN, smoking)
• Diet-reduce sodium, do a DASH diet (dietary approaches to stop
hypertension) and reduce BMI. Decrease cholesterol, saturated fats, and
sugars
, • Medications:
• ACE inhibitors
• Antiplatelet (ASA clopidigrel)
• Watch clopidogrel when used with omeprazole-increases risk
of MI and stroke
• Anticoagulants (Warfarin)
• Care of the leg with Limb Ischemia:
• Basic care and comfort:
• Carefully inspect, cleanse, and lubricate feet to prevent skin irritation
• Do not lubricate between the toes! (prevents breakdown)
• Cover ulcers with a dry, sterile dressing
• Wound care
• Encourage soft, roomy protective footwear
• Wear clean, all-cotton or all-wool socks and soft insoles
• Tie shoes loosely
• Keep heels free of pressure
• Surgical:
• PTA
• Peripheral artery bypass
• Endarterectomy
• Amputation
• Post-surgical or radiologic care:
• Check operative extremity every 15 minutes initially, then hourly.
• Assess color, temperature, capillary refill, presence of
peripheral pulses, and sensation and movement
• Loss of palpable pulses or change in Doppler sound over a
