NSG 326 Adult Health IPeripheral Arterial Disease (PAD)Slide 3PADPAD (cont.)PAD DiagnosisThe illustration shows the ankle-brachial index (ABI) test. The ABI gives the ratio of the systolic blood pressure in the ankle to the systolic blood pressure in the brachial artery of the arm.The illustration shows the location of leg arteries that can be affected by peripheral arterial disease. Figure A shows a normal artery with normal blood flow (the inset image shows a cross-section of the normal artery). Figure B shows an artery with plaque buildup, which is partially blocking blood flow (the inset image shows the degree to which the artery is blocked).Carotid Artery DiseaseSlide 10Slide 11Carotid Artery Disease (cont.)Slide 13Carotid EndarterectomyEpisodic Vasospastic DisorderSlide 16Venous ThrombosisVirchow’s TriadSlide 19Superficial ThrombophlebitisSlide 21Chronic Venous Insufficiency and Venous Leg UlcersSlide 23Varicosities or Varicose VeinsVASCUALR DISORDERSPrepared & Adapted by Dr. K. A. EnnenCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Peripheral arterial disease (PAD) occurs when a fatty material called plaque builds up on the inside walls of the arteries that carry blood from the heart to the head, internal organs, and limbs. PAD is also known as atherosclerotic peripheral arterial disease.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Fig. 38-1Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.At least half of the people who have peripheral arterial disease (PAD) don't have any signs or symptoms of the disease.People who do have signs or symptoms may have lower extremity pain when walking or climbing stairs, which may be relieved after resting. This pain is called intermittent claudication. ◦Blood brings oxygen to the muscles, but during exercise, muscles need more blood flow. If there is a blockage in the blood vessels, muscles won't get enough blood. ◦If a person has intermittent claudication and exercises while in pain, his or her muscles may be harmed. When resting, the muscles require less blood flow and the pain goes away. ◦Claudication is more likely in people who also have atherosclerosis in other arteries, such as the heart and brain. ◦About 10 percent of people with PAD have intermittent claudication.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Other signs and symptoms of PAD include:◦Pain, numbness, aching, and heaviness in the muscles ◦Cramping in the legs, thighs, calves, and feet ◦A weak or absent pulse in the legs or feet ◦Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all ◦Color changes in skin, paleness, or blueness (called cyanosis) ◦A decreased temperature in one leg compared to the other leg ◦Poor nail growth and decreased hair growth on toes and legs ◦Erectile dysfunction, especially among people with diabetesCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Peripheral arterial disease (PAD) is diagnosed based on general medical and family history, history of leg or heart problems, personal risk factors, a physical exam, and test results. ◦An accurate diagnosis is critical, because people with PAD face a six to seven times higher risk of heart disease or stroke than the rest of the population. ◦PAD is often diagnosed after symptoms are reported. If you have PAD, your doctor also may want to look for signs of coronary artery disease (CAD). A simple test called an ankle-brachial index (ABI) can be used to diagnose PAD. ◦The ABI compares blood pressure in the ankle with blood pressure in the arm to see how well blood is flowing. ◦A normal ABI is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10-15 minutes to measure both arms and both ankles. It can help the doctor find out if PAD is affecting the legs, but it will not identify which blood vessels are blocked. The ABI can be performed yearly if necessary to see if the disease is getting worse.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Carotid artery disease may not cause any noticeable symptoms in the early stages. However, as the arteries become narrower, an individual may experience symptoms indicating impaired blood flow to the brain, such as numbness or weakness on one side of the body, difficulty speaking or vision problems. These symptoms can vary in length and could be an indication of a transient ischemic attack (TIA) or stroke.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.The disease is usually diagnosed during an individual’s routine physical examination. Based on the patient’s symptoms, the physician listens to the carotid arteries through a stethoscope to determine if any telltale sounds (bruits) are present. Other tests that may be ordered include a carotid doppler ultrasound, magnetic resonance angiogram (a type of MRI), CAT scan and/or a carotid angiogram.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Once a diagnosis has been made, patients are generally urged to make lifestyle changes such as a eating a healthier diet, quitting smoking and getting regular exercise. Under supervision of a physician, a daily dose of aspirin (81 to 325 milligrams), or other antiplatelet or anticoagulant drugs, may be prescribed to reduce the risk of stroke by helping to prevent blood clots. Statins, which are used to lower cholesterol, also may be used to help prevent stroke.For patients with more serious carotid artery disease, surgery (carotid endarterectomy) or less-invasive procedures, such as carotid artery stenting, may be recommended. During endarterectomy, the surgeon opens the arteries and strips away plaque that is clogging the vessel. During carotid