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1. Bilateral Blood Pressure: Patients with PAD are at an increased risk for subclavian artery stenosis (narrowing of the artery), when the blood pressure difference is 15-20 mm Hg higher it could suggest this.

2. Palpate all pulses in both legs: Weak and/or absent pulses are a sign of poor blood flow to that extremity.

3. Visual assessment of feet and limbs: You are looking for signs of ulcers forming, loss of hair on the lower limbs, and poor blood flow to the feet.

4. Temperature: Cool or cold temperature in the extremities signify poor blood flow.

5. Assess bilateral muscle tone: Muscle atrophy can accompany prolonged chronic arterial disease.

6. Assess Pain: Pain in the affected extremities with activity that is relieved with the is indicative of PAD.

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Assessment:

Pulse palpation will be low/absent in the pedal/popliteal

Auscultate for bruits

Inspect legs/feet for necrosis/gangrene

Confirm findings with Dx testing

Ankle Brachial Index:

Complete with a Doppler probe.

Used to compare the BP of the ankle with the BP of the brachial artery.

ABI = Ankle BP/Brachial BP

Normally, the ankle BP should be more than the brachial artery, so a ratio below 1.29 indicates PAD.

0.99-0.99 = Boarderline PAD

0.41-0.9 - Mild-Moderate PAD

0-0.4 = Severe PAD

The BP is lower because blood flow is being restricted.

Plethysmography

Pulse volume is used to detect changes in the volume flowing through a limb

Waveforms decrease with PAD

Treadmill test

Confirms diagnosis of intermittent claudication and PAD

Duplex Ultrasound

velocity of blood flow

Computed Tomography Angiography (CTA)

CT Scan to visualize the vessels

Angiography

Quantifies the narrowing of occluded vessels.

LABs:

Lipid profile

evaluate risks for vascular disease

Coagulation tests

INR to test clotting time (possible warfarin use)

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1. Positioning: Avoid crossing the legs as this can obstruct blood flow.

2. Inspect feet daily: This should be monitored daily as patients with PAD are at a higher risk for developing ulcers on the bottom of the feet and between the toes.

3. Report chest discomfort or neurological changes immediately: These patients have an increased risk for developing chronic Angina, MI, or Stroke.

4. Lifestyles changes consistent with the management of atherosclerosis: DASH diet (1,600 mg Sodium restriction), limit alcohol intake, smoking cessation, moderate exercise

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Modifiable Risk:

-Aging

-Diabetes

-Smoking

-Hypertenstion

-Dyslipidemia

-Sedentary Lifestyle

-Obesity

-Ineffective Stress Management

Nonmodifiable risk factors:

-age

-gender

-ethnicity

-Family History

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Progressive & Chronic Condition in which blood flow is obstructed through LARGE peripheral arteries.

This causes partial or total arterial occlusion.

PAD deprives the lower extremities of O2 & nutrients.

This results in inadequate tissue perfusion (ischemia and necrosis or cell death)

Causes:

Combination of atherosclerosis, inflammation, stenosis, embolus, & thrombus

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Provide relief for symptoms

Prevent progression of cardiovascular disease

Improve quality of life

Provide patient education

Weight reduction'

Smoke cessation

Exercise

Low-fat diet

Surgical treatment

Medications

Medications:

Hypertensive meds or beta blockers to achieve blood pressure control

Antiplatelet (Asprin or clopidogrel) Improves blood flow and intermittent claudication symptoms

Lipid lowering statins to reduce total cholesterol

Vasodilators (ACE inhibitors) dilate blood vessels by blocking the formation of angiotensin II which is a vasoconstrictor

Hemorheological agents (Trental) lowers blood viscosity by inhibiting platelet aggregation which increases blood flow to affected extremity

NOTE: These medications can cause symptoms of headache, dizziness, diarrhea or palpitations that could potentially cause the patient to discontinue medications. - Patient education is very important!

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Risk for impaired skin integrity due to altered circulation or sensation.

CRITICAL LIMB ISCHEMIA: a sustained, severe decline of arterial blood flow to the affected extremity leading to chronic ischemia, pain at rest, ulceration gangrene, and ultimately limb loss if left untreated.

ACUTE LIMB ISCHEMIA: a sudden decrease in blood flow to an extremity that threatens tissue viability. May be FIRST manifestation of PAD in a previously asymptomatic patient, or it may be caused by an acute event that leads to symptomatic deterioration in a patient with lower extremity PAD and intermittent claudication.

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Artery = AWAY from the heart, when blocked, blood can't flow to the tissue -> Ischemia (pain) caused by the lack of O2.

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-Pain

-Pallor (pale)

-Pulselessness (weak or absent pulses to affected area)

-Paresthesia (tingling,numbness, & burning)

-Paralysis

-Poikilothermia (cool or cold)