Hey guys! This week we are moving in the completely opposite direction from the heart. This week we are talking about disease processes that impact the peripheral venous and arterial vessels.

What is peripheral vascular disease (PVD)?

The result of narrowed and constricted arteries (stenosis, outside of leading to a decrease in blood flow to the extremities.

What is peripheral artery disease (PAD)?

PAD is considered to be a type of PVD as the term vascular in Peripheral Vascular Disease can refer to all peripheral vessels. PAD indicates narrowing of arteries outside of the heart, primarily in the legs, which leads to poor circulation in the extremities.

In many cases, PAD and PVD are used interchangeably, even on the National Institute of Health’s Website, here.

What causes PAD/PVD?

PAD/PVD can have a number of origins. Some common risk factors and origins are as follows.

• Physical inactivity

• Smoking or use of tobacco products

• Coronary artery disease

• High blood pressure

• Being over 55 years old and older.

• History of heart disease

• Postmenopausal women

• Being obese or overweight.

• Diabetes

• High cholesterol

• Being male

• Having a family history heart and vascular

How to prevent PAD/PVD?

• Tobacco/Nicotine cessation

• Low-Fat diet

• Manage diabetes mellitus well, keep HgbA1C Level Less than 7

• A regular exercise program, avoiding long periods of inactivity. Even doing pedal pushes while sitting…. Basically get up and move every once in a while…..

What are the signs and symptoms of PVD/PAD?

• Cramping of extremities, especially after activities like walking or climbing stairs, known as claudication.

• Leg numbness or weakness

• Discoloration of skin in the impacted extremity. Many people will have a darker tinting.

• Development of sores and ulceration on impacted extremities

• Development of a sheen or shiny quality to the legs

• No pulse or a weak pulse in your legs or feet

• Possible erectile dysfunction in men

• Bruits present in impacted extremities, which presents as whooshing sounds upon auscultation.

How do you treat PVD/PAD?

Diagnostic Methods

Radiography

• MRA - Like a MRI, but it focuses on imaging the blood vessels.

• Angiogram - X-RAY that examines blood vessels.

• Venous Ultrasound

• Ankle-Brachial Index (ABI) - Like taking a BP in the lower extremities and comparing it to your brachial blood pressure.

• Treadmill Exercise Stress Test - Not exactly the same as the stress test done to assess for CAD or Coronary Artery blockages, but the same concept.

Laboratory Tests

• CBC

• Lipid Profile

• Hemoglobin A1c

• Apolipoprotein A

• Screening for hypercoagulability

• Serum Homocysteine

Additionally, the degree of Occlusion or poor circulation can be graded using a number of classification systems, the most common being Rutherford's Classification system for peripheral vessel ischemia.

Treatments

Pharmacological

• Antiplatelet Therapy, Like Aspirin (ASA) or Clopidogrel (Plavix)

• Antihyperlipidemic medications, such as Statins, Like Atorvastatin (Lipitor) or Lovastatin

• Treatment for possible Hypertension

• Diabetes management

Procedural

• Angioplasty, sometimes with stent placement.

• Amputation for more severe cases.

• Peripheral Artery Bypass

Nursing Considerations

• Here is a cool checklist for PAD found on midline plus.

• Patients with PAD/PVD should NOT wear compression stocking/TED hose. They will further compress already poor circulation. Here is a good article mentioning why this is the case.

• Don’t think that PAD can’t impact the arms, because it can. Although PAD in the arms is not common.

Thanks for listening. Keep pumping……

Sources

Family Practice Notebook Website & App

NIH National Heart, Lung, and Blood Institute Website

Medical Surgical Nursing, Demystified 2nd Edition

Stanford Healthcare Website

American Heart Association Website
 

This post was written by Patrick of PatMacRN.com. Patrick works as CVICU nurse and Float Pool Nurse at an Academic medical center. In his spare time, Patrick enjoys reading, traveling, and improving his French Language skills.

Disclaimer: This material should be used to supplement your understanding of the cardiovascular system. Any use of the information given in this post series is at your own risk and should be verified prior to making it a part of your nursing practice. There may be affiliate links associated with some products but we promise that we will never recommend anything that we don’t use ourselves.