Download Peripheral Arterial Disease and Acute Arterial Occlusion notes

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Peripheral Arterial Disease and Acute Arterial Occlusion
John Miller
Peripheral artery disease (PAD)
 Primary risk factors
o Atherosclerosis
 Narrowed peripheral arteries with impaired blood supply.
 Femoral and popliteal aneurysms
o Diabetes
o Smoking
 Secondary risk factors
o Lower limbs more susceptible to arterial occlusion
 Disease or embolism usually occur in bifurcations.
 Most common areas: aortoiliac bifurcation and femoral bifurcation
o Claudication symptoms more in men, at 60-70 years
o Almost 50% with claudication have coronary artery disease.
o Increased incidence for women after menopause.
Anti-smoking PSA - Heart Issues, StopSmoking4Life, http://youtu.be/DoIZCnp_Wp8
Associated diseases
 Coronary artery disease (CAD), myocardial infarction
 Atrial fibrillation
 Carotid stenosis, stroke
 Renal failure
 Hypertension
 Hyperlipidemia (hypercholesterolemia)
Causes of acute occlusions
 Embolism
o Atrial fibrillation, atherosclerosis (atheroma), tumor
 Thrombosis
o Obesity
o Sepsis
o Hypotension, low cardiac output
o Aneurysms, aortic dissection
o Bypass graft
o Atherosclerosis (atheroma)
 Trauma
 Vasospasm
 Edema
Pathophysiology
 Collaterals arterioles develop slowly in response to low oxygen levels.
 Vasodilation has a limited effect
 Anaerobic metabolism causes lactic and pyruvic acid build up
 Lack of flow causes pain (intermittent claudication) when muscle is forced to work without adequate
blood supply.
 Acute or chronic
o Three layers include intima, media, and adventitia.
o Vasoconstriction, vasodilation
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Assessment
 Can be asymptomatic.
 Diminished or absent pulses
 Intermittent claudication
o Calves or buttocks
o Sharp cramp or burning sensation
o Does not occur with sitting or standing
 Rest pain
 Pain worsens with leg elevation.
 Elevation pallor
o Elevate foot 12 inches
o Pallor within 1 minute
o Put in dependent position, color takes more than 10 seconds to return.
Paresthesias
 Arterial steal: arterioles in muscle steal from cutaneous and peripheral nerves, resulting in coldness and
pins and needles sensation
 Numbness, decreased sensation
Patterns of claudication in distal tissues
 Aorto-iliac occlusion
o Gluteal and thigh pain
 Femoral occlusion
o Calf pain
 Popliteal / tibial occlusion
o Calf or foot pain
 Leriche syndrome
o Impotence is caused by occlusion.
Arterial versus Venous problem comparison
 Arterial
o Decreased to absent pulses
o Pale with dependent rubor
o Thick toenails if fungal infection is present
o Edema usually absent
o Cool. Absence of hair; thin, shiny skin
o Muscle mass reduced
o Decreased sensation
o Ulcers
 Small, painful
 Points of trauma
 Between toes
 Distal most point: lateral malleolus or toes

Venous
o
o
o
o
o
o
Decreased pulses from edema
Brown discoloration, dependent cyanosis
Normal toenails
Edema worse at the end of day
No change in temperature or may be warmer
Muscle mass not reduced
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o
o
Pruritus
Ulcers




Broad
Shallow
Slightly painful ulcers of ankle and lower leg
Surrounding skin is brown and fibrotic
Ankle-brachial index
 Supine position, take both arm BPs
 Regular BP cuff applied to leg just above malleolus
 Doppler used to find dorsalis pedis and posterior tibial pulses
 Ankle-brachial index (ABI)=
systolic ankle pressure / higher systolic BP of arm (example 60/120=0.5)
o 1 or more is normal
o 0.5-0.8 experience claudication
o 0.4 or less experience rest pain
o ABI falsely elevated in diabetes, so use toe-brachial index instead
Complications
 Gangrene
 Extremity amputation
 Infection
 Sepsis
Search on YouTube, which has examples and amputations.
Lab tests
 Elevated Tests (normal range)
o Hgb (40-54 men, 36-46 women)
o BUN (3-20)
o Cr (0.5-1.2 men, 0.4-1.1 women)
o Na (135-145)
o Lipids
 LDL (less than 100)
 HDL-C (greater than 39 men, greater than 40 women)
 Total cholesterol/HDL ratio (less than 5)
 Triglycerides (less than 150)
o Total homocysteine
Diagnosis
 Segmental pressure measurements: Cuff pressures on different limbs and places on limbs.
 Stress testing: Treadmill or exercise stress test monitoring ECG and for pain.
 Duplex Doppler ultrasound: Ultrasound to assess flow in arteries.
 Transcutaneous oximetry: Measure SpO2 in skin of affected limbs.
 Magnetic resonance angiography (MRA): Uses MRI.
 Angiography
Multi-point Segmental Blood Pressure Test - How it Works - Blue Ridge HealthCare
https://youtu.be/g77EgNWBIZg
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Exercise stress testing
 Purpose
o Measure severity of claudication
o Measure the degree which claudication interferes with patient’s lifestyle
 Treadmill
o 1.5-2 mph, 10-20 degree elevation,
o Mild symptoms if can walk 5 minutes before pain
o Severe disease if can walk only 1 minute
Stress test patient preparation
 Preparation
o Comfortable clothing, two pieces, top removed
o No powder or lotion
o Nothing to eat or drink 2 hours before except clear liquids not containing caffeine.
o Provider may have beta blockers held prior.
o Takes 1-1.5 hours.
o Dobutamine may be given if cannot exercise, so the heart is stressed. Increases heartrate and
force of contraction.
 During test: Life threatening dysrhythmias or chest/leg pain can occur.
 Post test: No special limitations.
What to Expect from an Echocardiogram or Stress Test | IU Health Heart & Vascular Care
https://youtu.be/JVNSIVE347c
VASCULAR #2 Arterial Doppler and Imaging (Duplex Doppler)
https://youtu.be/XykKUrw-SQ4?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
Transcutaneous Oximetry - Part 1 - What We Are Measuring https://youtu.be/Y9xIELtCJ1Y
Transcutaneous Oximetry - Part 5 - Predicting Benefit from HBO Therapy https://youtu.be/K6VfW6mr8lM
What is a Magnetic Resonance Imaging (MRI) scan? https://youtu.be/Qbnz4_qed9Q
Femoral Angiogram/Angioplasty with OEC Hybrid OR https://youtu.be/le0tB8jc1nE
Angiography
 Preoperative or intraoperative
 Performed in a vascular (cath) lab with xrays
o Sterile conditions
o Catheter inserted through sheath (introducer)
 Local anesthetic
 Contrast injected
 Fluoroscopy to check catheter position
Angiography preprocedure care
 Informed consent
 NPO 2-6 hours
 Mild sedative
 Prep femoral site
 Assess renal function, BUN and Creatinine
o Poor renal function will not clear the contrast dye from the body.
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Angiography postprocedure care
 Frequent vascular assessment
o Vital signs
o Neurologic function
o Distal pulses, distal color
o Puncture site for hematoma
 Bed rest 6-8 hours
o Affected extremity straight alignment, without flexion
 Crystalloid IV fluid for 6-8 hours to flush out contrast, encourage oral intake
o Check BUN and creatinine levels the next day
More Angiography postprocedure
 Resume all orders, except heparin until hemostasis is evident
 Manage pain with mild analgesics, severe pain may be a hematoma
 Report any vascular changes immediately
 Complications
o Allergy to contrast, thrombi, emboli, artery perforation, renal failure, pseudoaneurysm
FemoStop Gold Product Demonstration Video https://vimeo.com/150287535
Angio Seal https://youtu.be/TbTRH5VquIE
Cardiac Cath and/or Peripheral Angiography -Preprocedure Version (Orders)
http://orders.benefis.org/ordersdoc/Cardiology/Cardiac%20Cath%20and-or%20Peripheral%20AngiographyPreprocedure.pdf
Physician Orders ADULT Order Set: RAD Arteriogram (Femoral) Post Procedure
http://www.methodistmd.org/dotAsset/584d19ce-f4f4-4347-8d9f-dcc6cf79e042.pdf
Interventions
 Medications
 Exercise and dietary changes
o Control diabetes and hypertension
o Lower cholesterol levels
o Weight loss
 Skin and foot care
 Smoking cessation
Medications
 Antilipemics
 Anticoagulants
o Heparin, warfarin
o Direct thrombin inhibitors
o Antiplatelets
Medications: Antilipemics
 Antilipemics
o HMG CoA Reductase Inhibitors (Statins)
o Cholesterol Absorption Inhibitor
o Bile-Acid Sequestrants
o Niacin
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o
Fibrates
HMG CoA Reductase Inhibitors (Statins): Atorvastatin
 Class: Antilipemic, HMG CoA Reductase Inhibitor-Statin
 Therapeutic effect: Reduce LDL, VLDL. Increase HDL. Increase vasodilation. Decrease plaque
inflammation and thromboembolism.
 Use: Hypercholesterolemia, angina-MI, CVA
 Adverse effects
 Liver toxicity: Check AST level and stop medication if elevated. Check for hepatitis: anorexia, N&V,
jaundice.
 Myopathy: Muscle pain, check CK and stop medication if elevated. May progress to myositis or
rhabdomyolysis.
Atorvastatin
 Contraindications/Precautions
o Pregnancy risk X
o Contraindicated in liver disease (hepatitis).
 Interactions
o Fibrates increase risk of myopathy.
o Erythromycin and ketoconazole increase statin levels.
o Grapefruit juice increases statin levels. Do not drink more than one quarter daily.
 Take tablet in evening.
Cholesterol Absorption Inhibitor: Ezetimibe
 Class: Antilipemic, cholesterol absorption inhibitor
 Therapeutic Effect: Inhibits cholesterol from food and bile.
 Use: Lower cholesterol with or without statin and modified diets
 Adverse effects
o Liver toxicity: Check AST level and stop medication if elevated. Check for hepatitis: anorexia,
N&V, jaundice.
o Myopathy: Muscle pain, check CK and stop medication if elevated. May progress to myositis or
rhabdomyolysis.
Ezetimibe
 Contraindications/Precautions
o Pregnancy risk X
o Contraindication in moderate to severe liver disease, especially when taking statin.
 Interactions
o Bile acid sequestrants interfere with absorption. Take 1 hour before or 4 hours after bile
sequestrants.
o Statins can increase liver dysfunction and myopathy.
o Fibrates can increase risk of cholelithiasis and myopathy.
o Cyclosporine increases ezetimibe levels.
Bile-Acid Sequestrants: Colesevelam
 Class: Antilipemic, bile-acid sequestrant
 Therapeutic effect and use: Adjunct with statin to lower LDL.
 Adverse effects: Constipation, eat high fiber and drink fluids.
 Contraindications/Precautions
o Pregnancy risk B
o Contraindicated in pancreatitis caused by high triglycerides and bowel obstruction.
o Caution with gall bladder disease, diabetes mellitus.
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
Interactions
o Interfere with: levothyroxine, glipizide, vitamins A,D, E, K, oral contraceptives. Take these four
hours before colesevelam.
Antilipemic: Niacin
 Class: Antilipemic
 Therapeutic effect and use:
o Lower LDL and triglycerides, raise HDL. (Niacin trade drug Niaspan only)
o Patients at risk for pancreatitis and with elevated triglyceride levels
Niacin
 Adverse effects
o GI distress: Take with food. Time release take in evening.
o Facial flushing, warmth, tingling of hands and feet: Take aspirin 30 minutes before.
o Hyperglycemia: Monitor glucose.
o Liver toxicity: Check AST level and stop medication if elevated. Check for hepatitis: anorexia,
N&V, jaundice.
o Hyperuricemia: Monitor renal function (BUN, Cr, I&O). 2-3L H2O intake. If uric acid elevated,
take allopurinol.
 Contraindications/Precautions
o Pregnancy risk C
o Contraindicated in liver disease or gout.
Fibrates: Gemfibrozil
 Class: Antilipemic, fibrate
 Therapeutic effect and use:
o Increase HDL levels.
o Decrease triglyceride (VLDL) level for those unable to lower level with lifestyle modification or
other antilipemics.
 Adverse effects
o GI distress: Oral and 30 minutes prior to meals.
o Myopathy: Muscle pain, check CK and stop medication if elevated. May progress to myositis or
rhabdomyolysis.
o Liver toxicity: Check LFTs and stop medication if elevated. Check for hepatitis: anorexia, N&V,
jaundice.
Gemfibrozil
 Contraindications/Precautions
o Pregnancy risk C
o Contraindicated in those with liver, gallbladder, or renal disease.
 Interactions
o Warfarin: Concurrent use increases bleeding. Monitor INR and for active bleeding.
o Statins: Concurrent use should be avoided because increases muscle pain.
Anticoagulants: Direct Thrombin Inhibitors: Dabigatran
 Class: Anticoagulant, direct thrombin inhibitor
 Therapeutic effect: Inhibits thrombin, preventing thrombus.
 Use: Prevent stroke or embolism in Atrial Fibrillation not caused by valvular disease.
 Adverse effects
o Bleeding
 Stop before surgery.
 No antidote. Dialysis or recombinant factor VIIa may help.
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o
GI: N&V, reflux, ulcer
 Take with food. May need PPI or H2 antagonist.
Dabigatran
 Contraindications/Precautions
o Pregnancy risk C
o Contraindicated in active bleeding
o Caution with liver disease, who are prone to bleed.
o Caution with renal disease.
 Interactions
o Rifampin decreases dabigatran levels.
Antiplatelet: Aspirin
 Class: Antiplatelet and arterial vasodilator
 Therapeutic effect: Inhibit platelet aggregation (clumping) preventing clotting.
 Use: Prevent MI and additional episodes. Prevent ischemic CVA.
 Adverse effects: Dyspepsia, N&V
o Take with food.
o Use enteric coated tablet. Do not crush.
o Take PPI or H2 antagonist to reduce acid.
o Hemorrhagic CVA
o GI bleed, thrombocytopenia
o Tinnitus, hearing loss
Aspirin
 Contraindications/Precautions
o Pregnancy Risk D
o Contraindicated for those with bleeding disorders and thrombocytopenia.
o Caution with peptic ulcer, severe renal or hepatic disease.
o Do not give to children or adolescents with fever or recent chickenpox.
 Interactions
o Concurrent anticoagulants or NSAIDs increase bleeding risk.
o Ammonium chloride may increase aspirin levels.
o Beta blocker therapeutic effect may be reduced by aspirin.
o Corticosteroids may reduce aspirin levels.
o Caffeine may increase aspirin levels.
Antiplatelet: Abciximab
 Class: Antiplatelet and arterial vasodilator
 Therapeutic effect: Inhibit platelet aggregation (clumping) preventing clotting.
 Use: Acute coronary syndrome (MI) intervention in cardiac cath lab
 Adverse effects:
o Hypotension, bradycardia
o Bleeding, thrombocytopenia
Abciximab
 Contraindications/Precautions
o Pregnancy Risk C
o Contraindicated for those with bleeding disorders and recent surgery.
o Caution with peptic ulcer, renal or hepatic disease.
 Interactions
o Concurrent anticoagulants and NSAIDs increase bleeding risk.
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Antiplatelet: Clopidogrel
 Class: Antiplatelet and arterial vasodilator
 Therapeutic effect: Inhibit platelet aggregation (clumping) preventing clotting.
 Use: Acute coronary syndrome (MI) intervention in cardiac cath lab
 Adverse effects
o Bleeding, thrombocytopenia
o Diarrhea, gastric symptoms of belching, heartburn, etc.
Clopidogrel
 Contraindications/Precautions
o Pregnancy Risk B
o Contraindicated for those with bleeding disorders.
o Caution with peptic ulcer, renal or hepatic disease.
o Do not breastfeed.
 Interactions
o Concurrent anticoagulants and NSAIDs increase bleeding risk.
o PPIs decrease clopidogrel levels.
Antiplatelet: Pentoxifylline and Cilostazol
 Class: Antiplatelet and arterial vasodilator
 Therapeutic effect: Inhibit platelet aggregation (clumping) preventing clotting.
 Use: Intermittent claudication, oral
 Adverse effects of pentoxifylline
o Dyspepsia, N&V
 Take with food.
 Do not crush.
 Increases theophylline level. Monitor drug level.
Pentoxifylline
 Contraindications/Precautions of pentoxifylline
o Pregnancy Risk C
o Contraindicated for those with bleeding disorders.
 Interactions of pentoxifylline
o Concurrent anticoagulants increase bleeding risk. Monitor PT and INR.
Exercise
 Walk 45-60 minutes per day.
 Stop at onset of pain. When subsides, continue.
 Promotes
o Increased collateral blood vessels to send blood around the blockage.
o Higher HDL levels
o Lower LDL, triglyceride, and blood glucose levels
o Greater insulin sensitivity
o Lower body mass index
Exercise recommendations
 American Heart Association Recommendations for Physical Activity in Adults
http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/StartWalking/American-HeartAssociation-Guidelines-for-Physical-Activity_UCM_307976_Article.jsp#.VxQQyTArKHs
See slide for details.
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American Heart Association Dietary Guidelines
 Variety of fruits and vegetables
 Whole grains
o Fiber (women 25 GMs, 21 if over 50 years) (men 38 GMs, 30 if over 50)
 Fat
o Polyunsaturated, monosaturated (olive, avocado, nuts), omega 3 oil (fatty fish)
o Skinless poultry and fish, low fat dairy, nuts and legumes
o Non-tropical vegetable oils. Palm is a tropical oil.
o Limit transfats - also known as partially hydrogenated oil (in most processed food)
o Limit added sugar in foods.
 Sodium (limit to 2,500 mg, 1,500 is even better), potassium
 Alcohol in moderation: 2 drinks each day men, 1 each day women.
 Detailed diet: DASH diet
The American Heart Association's Diet and Lifestyle Recommendations
http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-AssociationsDiet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.VxQSkTArKHs
Managing Blood Pressure with a Heart-Healthy Diet
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/PreventionTreatmentofHighBloodPressure/
Managing-Blood-Pressure-with-a-Heart-Healthy-Diet_UCM_301879_Article.jsp#.VxQURzArKHs
Obesity
 High risk waist size: men greater than 40 inches, women greater than 35 (diabetes risk increases also)
 Body mass index goal: 18-25. 30 or higher is considered obese.
 Loss of at least 10-20 pounds will reduce risk.
 Alternating pattern of weight gain and loss is higher risk for CHD and PAD.
Obesity Information http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/ObesityInformation_UCM_307908_Article.jsp#.VxQYOTArKHs
Calculate Your Body Mass Index http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
Diabetes
 Diabetics have a much higher risk of PAD and CHD, occurs earlier and is more accelerated.
o Monitor Hgb A1C
 Diabetes 6.5% and higher
 Pre-diabetic: 5.7-6.4%
Skin care
 Good shoes that protect and allow air flow
 Avoid elastic support hose
 6 inch shock blocks under the head of bed (reverse Trendelenburg)
 Fleece boots, heels floated off the bed, heel protector, bed cradle
 Keep warm, reduce stress, legs below heart level
 Avoid crossing legs or standing in one place for a long time.
 Lotion avoided between toes.
 Keep feet dry, cotton socks
 Elevate feet slightly if swell.
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About Peripheral Artery Disease (PAD)
http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/About-Peripheral-ArteryDisease-PAD_UCM_301301_Article.jsp#.VxQaFzArKHs
Endovascular Interventions in Catheterization Lab
 Local anesthesia, quick recovery, with angiography
o Angioplasty (PTCA) with stent placement
o Atherectomy
Treatment of Critical Limb Ischemia with Balloon Angioplasty and Stents https://youtu.be/UOXQbF3K56g
Atherectomy [www.keepvid.com] https://youtu.be/wTrYH9_jFx4
Arterial bypass
o Aortoiliac blocked
 Usually aortobifemoral bypass graft is performed, synthetic material.
o Femoral-popliteal graft
 Saphenous vein is used (SVG).
o Complication
 Clots in graft causing an acute arterial occlusion
o Anticoagulants (ASA, heparin, LMW heparin)
o Fibrinolytics if stable after surgery
Minimally Invasive Vascular Surgery
https://youtu.be/gsM8k0sLT0k?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
Vascular Surgery: Aorto Bifemoral Grafting for Complete Aorto-Iliac Block
https://youtu.be/J-eQF97FnYc?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
Aorto Bi-femoral Grafting.wmv https://youtu.be/3GnFRCj-tFs?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
Aortobifemoral bypass surgery by Cal Shipley, M.D.
https://youtu.be/f3wmmPo6Rs0?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
Preoperative Interventions
 Pulses with doppler, marked
 Assess for other atherosclerosis problems such as with heart, brain, kidneys.
 Reverse malnutrition.
 Clean wounds.
 Resolve all infections, especially if synthetic graft (Gortex, PTFE) is used.
Postoperative Interventions
 Adequate vascular volume
o Stable BP, good u/o, skin warm, intake = output, stable Hgb and Hct
o Keeps graft patent.
 Supine position
 Pain meds for 48-72 hours
 Avoid flexion at the operative site.
 ROM, ambulation
 Avoid tape on legs
 Assess pulses, neurological status of extremities
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Complications of surgery
 Hemorrhage
o Disrupt suture line
o Pseudoaneurysm
 Clotting of graft
 Infection (if synthetic graft it must be removed)
 Compartment syndrome
o Causes loss of nerve and motor function, acute tubular necrosis.
o Signs: severe pain, tense swollen leg, pain with passive stretching, decreased sensation, rusty
brown urine (myoglobinuria)
Carotid Endarterectomy
 Similar care postop as with other arterial surgery
 Distal pulses checked include temporals.
 Assess neurological function.
UCLA Vascular Surgery - Carotid Endarterectomy Procedure 2
https://youtu.be/Z-2wsztt3bA?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
Thromboangitis Obliterans
 Also known as Buerger disease
 Occlusive vascular disease
 Pathophysiology and course
o Inflammation and spasm in small and midsize peripheral arteries, causing clots to form
o Intermittent with dramatic exacerbations and marked remissions
Assessment
 Manifestations
o Pain in affected extremities
o Claudication and cramping
o Rest pain
o Skin is thick and shiny; nails thickened.
o Distal pulse is hard to locate
o Painful ulcers and gangrene
Incidence and risk factors
 Men under age 40 who smoke
 More prevalent in Asians, people of eastern European descent
 Cigarette smoking is most significant cause.
Diagnosis
o
o
o
History and physical examination
Doppler studies
Angiography and MRIs
Buerger's Disease Interventions
https://youtu.be/K2P4FWFGObM?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
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Interventions
 Promotion of Arterial Circulation
 Prevention of Prolonged Tissue Hypoxia
 Smoking Cessation Support
 Relief of Acute Manifestations
 Surgical Interventions
o Sympathectomy
o Arterial bypass graft
Raynaud Disease
 Disease and phenomenon
 Pathophysiology and manifestations
o Episodes of intense vasospasm in the small arteries and arterioles of fingers and toes
o No identifiable cause; can occur secondary to another disease
Raynaud's Disease https://youtu.be/pjar6pXxQ34?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
Assessment
 Pathophysiology and manifestations
o Primarily affects young women
o Manifestations
 "The blue-white-red disease"
o Diagnosis
 History and physical examination
Raynaud's Phenomenon in real time
https://youtu.be/NSn8PTJndBA?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I
Interventions
 Medications
o Vasodilators (prostaglandin): Iloprost
o Sustained-release calcium channel blockers: Nifedipine
Interventions
 Keep hands warm
 Measures to avoid injuries
 Smoking cessation
 Stress reduction measures
 Diet
 Exercise
 Maintain normal body weight
Acute Arterial Occlusion
 Occurs by thrombus or embolism
 Risk for necrosis and gangrene
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Pathophysiology
o Arterial thrombosis
 Thrombus
 Blood clot that adheres to vessel wall
o Arterial embolism
 Sudden obstruction of blood vessel by debris
 Thromboembolus
Assessment
 Six P’s (Use for all arterial problems previously mentioned.)
o Pain
o Pulselessness
o Poikilothermic (coldness)
o Pallor –can progress to mottled and cyanotic
o Paresthesias
 Numbness, tingling, pins and needles
 Loss of position sense
 Cannot detect pressure or pin prick.
 Cannot tell whether toes are flexed or extended
o Paralysis
o Muscle spasms
Interventions
 Surgical embolectomy
o Limited amount time to prevent permanent damage.
o Local anesthesia
o Anticoagulant medications
 To allow time to do embolectomy.
 Fibrinolytic medications
Acute, Complete Occlusion of the Leg Arteries
https://youtu.be/tttaSS9Z8hk?list=PLdVvae0BQcKztVN9VICTi25bXgmseXc0I