Peripheral Arterial Disease of the Lower Extremities
DescriptionDescription
PAD may affect Aortoiliac artery Femoral artery Popliteal artery Tibial artery Peroneal artery
PAD may affect Aortoiliac artery Femoral artery Popliteal artery Tibial artery Peroneal artery
Clinical ManifestationsClinical Manifestations
Classic symptom of PAD Intermittent claudication
Ischemic muscle ache or pain that is precipitated by a constant level of exercise
Classic symptom of PAD Intermittent claudication
Ischemic muscle ache or pain that is precipitated by a constant level of exercise
Clinical ManifestationsClinical Manifestations
Classic symptom of PAD Intermittent claudication
Resolves within 10 minutes or less with rest
Reproducible
Classic symptom of PAD Intermittent claudication
Resolves within 10 minutes or less with rest
Reproducible
Clinical ManifestationsClinical Manifestations
Paresthesia Thin, shiny, and taut skin Loss of hair on the lower legs Diminished/absent pedal,
popliteal, or femoral pulses
Paresthesia Thin, shiny, and taut skin Loss of hair on the lower legs Diminished/absent pedal,
popliteal, or femoral pulses
Clinical ManifestationsClinical Manifestations
Pallor Reactive hyperemia
Pallor Reactive hyperemia
Clinical ManifestationsClinical Manifestations
Rest pain Occurs in the forefoot or toes
and is aggravated by limb elevation
Occurs from insufficient blood flow
Occurs more often at night
Rest pain Occurs in the forefoot or toes
and is aggravated by limb elevation
Occurs from insufficient blood flow
Occurs more often at night
ComplicationsComplications
Atrophy of the skin and underlying muscles
Delayed healing Wound infection Tissue necrosis Arterial ulcers
Atrophy of the skin and underlying muscles
Delayed healing Wound infection Tissue necrosis Arterial ulcers
Diagnostic StudiesDiagnostic Studies
Doppler ultrasound Segmental blood pressures
Ankle-brachial index (ABI) Done using a handheld Doppler
Duplex imaging
Doppler ultrasound Segmental blood pressures
Ankle-brachial index (ABI) Done using a handheld Doppler
Duplex imaging
Diagnostic StudiesDiagnostic Studies
Angiogram Magnetic resonance angiography
(MRA) Health and physical examination
Include palpation of peripheral pulses
Angiogram Magnetic resonance angiography
(MRA) Health and physical examination
Include palpation of peripheral pulses
Collaborative CareRisk Factor ModificationCollaborative CareRisk Factor Modification
Smoking cessation Aggressive treatment of
hyperlipidemia Hypertension and diabetes
mellitus BP maintained < 130/85 Glycosylated hemoglobin < 7.0%
for diabetics
Smoking cessation Aggressive treatment of
hyperlipidemia Hypertension and diabetes
mellitus BP maintained < 130/85 Glycosylated hemoglobin < 7.0%
for diabetics
Collaborative CareDrug TherapyCollaborative CareDrug Therapy
Antiplatelet agents aspirin ticlopidine (Ticlid) clopidogrel (Plavix)
Antiplatelet agents aspirin ticlopidine (Ticlid) clopidogrel (Plavix)
Collaborative CareDrug TherapyCollaborative CareDrug Therapy
Drugs prescribed for treatment of intermittent claudication pentoxifylline (Trental) heparin cilostazol (Pletal)
Drugs prescribed for treatment of intermittent claudication pentoxifylline (Trental) heparin cilostazol (Pletal)
Collaborative CareExercise TherapyCollaborative CareExercise Therapy
Exercise improves oxygen extraction in the legs and skeletal metabolism
Walking is the most effective exercise for individuals with claudication 30 to 40 minutes/day
Exercise improves oxygen extraction in the legs and skeletal metabolism
Walking is the most effective exercise for individuals with claudication 30 to 40 minutes/day
Collaborative CareNutritional TherapyCollaborative CareNutritional Therapy
Dietary cholesterol less than 200 mg/day
Decrease intake of saturated fat Soy products can be used in
place of animal protein
Dietary cholesterol less than 200 mg/day
Decrease intake of saturated fat Soy products can be used in
place of animal protein
Collaborative CareComplementary/Alternative Therapies
Collaborative CareComplementary/Alternative Therapies
Ginkgo biloba Effective in increasing walking
distance for patients with intermittent claudication
Folate, vitamin B6, cobalamin (B12) Lowers homocysteine levels
Ginkgo biloba Effective in increasing walking
distance for patients with intermittent claudication
Folate, vitamin B6, cobalamin (B12) Lowers homocysteine levels
Collaborative CareCare of the Leg with Critical Limb Ischemia
Collaborative CareCare of the Leg with Critical Limb Ischemia
Protect from trauma Decrease vasospasm Prevent/control infection Maximize arterial perfusion
Protect from trauma Decrease vasospasm Prevent/control infection Maximize arterial perfusion
Collaborative CareInterventional Radiologic Procedures
Collaborative CareInterventional Radiologic Procedures
Indications Intermittent claudication
symptoms become incapacitating
Pain at rest Ulceration or gangrene severe
enough to threaten viability of the limb
Indications Intermittent claudication
symptoms become incapacitating
Pain at rest Ulceration or gangrene severe
enough to threaten viability of the limb
Collaborative CareInterventional Radiologic Procedures
Collaborative CareInterventional Radiologic Procedures
Percutaneous transluminal balloon angioplasty Involves the insertion of a
catheter through the femoral artery
Catheter contains a cylindric balloon
Percutaneous transluminal balloon angioplasty Involves the insertion of a
catheter through the femoral artery
Catheter contains a cylindric balloon
Collaborative CareInterventional Radiologic Procedures
Collaborative CareInterventional Radiologic Procedures
Percutaneous transluminal balloon angioplasty Balloon is inflated dilating the
vessel by cracking the confining atherosclerotic intimal shell
Percutaneous transluminal balloon angioplasty Balloon is inflated dilating the
vessel by cracking the confining atherosclerotic intimal shell
Collaborative CareSurgical TherapyCollaborative CareSurgical Therapy
Most common surgical approach A peripheral arterial bypass
operation with autogenous vein or synthetic graft material to bypass blood around the lesion
Most common surgical approach A peripheral arterial bypass
operation with autogenous vein or synthetic graft material to bypass blood around the lesion
Collaborative CareSurgical TherapyCollaborative CareSurgical Therapy
Endarterectomy Patch graft angioplasty Amputation
Endarterectomy Patch graft angioplasty Amputation
Nursing ManagementNursing AssessmentNursing ManagementNursing Assessment
Past Health History Diabetes mellitus Smoking Hypertension Hyperlipidemia Obesity
Past Health History Diabetes mellitus Smoking Hypertension Hyperlipidemia Obesity
Nursing ManagementNursing AssessmentNursing ManagementNursing Assessment
Exercise intolerance Loss of hair on legs and feet Decreased or absent peripheral
pulses
Exercise intolerance Loss of hair on legs and feet Decreased or absent peripheral
pulses
Nursing ManagementNursing DiagnosesNursing ManagementNursing Diagnoses
Ineffective tissue perfusion (peripheral)
Impaired skin integrity Acute pain Activity intolerance Ineffective therapeutic regimen
management
Ineffective tissue perfusion (peripheral)
Impaired skin integrity Acute pain Activity intolerance Ineffective therapeutic regimen
management