Peripheral Arterial

Disease of the Lower

Extremities
Description

 PAD may affect

 Aortoiliac artery

 Femoral artery

 Popliteal artery

 Tibial artery

 Peroneal artery
Clinical Manifestations

 Classic symptom of PAD

 Intermittent claudication

 Ischemic muscle ache or pain that

is precipitated by a constant level
of exercise
Clinical Manifestations

 Classic symptom of PAD

 Intermittent claudication

 Resolves within 10 minutes or

less with rest
 Reproducible
Clinical Manifestations

 Paresthesia
 Thin, shiny, and taut skin
 Loss of hair on the lower legs
 Diminished/absent pedal,
popliteal, or femoral pulses
Clinical Manifestations

 Pallor
 Reactive hyperemia
Clinical 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
Complications

 Atrophy of the skin and

underlying muscles
 Delayed healing
 Wound infection
 Tissue necrosis
 Arterial ulcers
Diagnostic Studies

 Doppler ultrasound
 Segmental blood pressures

 Ankle-brachial index (ABI)

 Done using a handheld Doppler

 Duplex imaging
Diagnostic Studies

 Angiogram
 Magnetic resonance angiography
(MRA)
 Health and physical examination
 Include palpation of peripheral

pulses
Collaborative Care
Risk Factor Modification

 Smoking cessation
 Aggressive treatment of
hyperlipidemia
 Hypertension and diabetes
mellitus
 BP maintained < 130/85
 Glycosylated hemoglobin < 7.0%
for diabetics
Collaborative Care
Drug Therapy

 Antiplatelet agents
 aspirin

 ticlopidine (Ticlid)

 clopidogrel (Plavix)
Collaborative Care
Drug Therapy

 Drugs prescribed for treatment

of intermittent claudication
 pentoxifylline (Trental)

 heparin

 cilostazol (Pletal)
Collaborative Care
Exercise 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
Collaborative Care
Nutritional Therapy

 Dietary cholesterol less than 200

mg/day
 Decrease intake of saturated fat
 Soy products can be used in
place of animal protein
Collaborative Care
Complementary/Alternative
Therapies

 Ginkgo biloba
 Effective in increasing walking

distance for patients with

intermittent claudication
 Folate, vitamin B6, cobalamin
(B12)
 Lowers homocysteine levels
Collaborative Care
Care of the Leg with Critical Limb
Ischemia

 Protect from trauma

 Decrease vasospasm
 Prevent/control infection
 Maximize arterial perfusion
Collaborative Care
Interventional Radiologic
Procedures

 Indications
 Intermittent claudication

symptoms become
incapacitating
 Pain at rest

 Ulceration or gangrene severe

enough to threaten viability of

the limb
Collaborative Care
Interventional Radiologic
Procedures

 Percutaneous transluminal
balloon angioplasty
 Involves the insertion of a

catheter through the femoral

artery
 Catheter contains a cylindric

balloon
Collaborative Care
Interventional Radiologic
Procedures

 Percutaneous transluminal
balloon angioplasty
 Balloon is inflated dilating the

vessel by cracking the

confining atherosclerotic
intimal shell
Collaborative Care
Surgical Therapy

 Most common surgical approach

 A peripheral arterial bypass

operation with autogenous

vein or synthetic graft material
to bypass blood around the
lesion
Collaborative Care
Surgical Therapy

 Endarterectomy
 Patch graft angioplasty
 Amputation
Nursing Management
Nursing Assessment

 Past Health History

 Diabetes mellitus

 Smoking

 Hypertension

 Hyperlipidemia

 Obesity
Nursing Management
Nursing Assessment

 Exercise intolerance
 Loss of hair on legs and feet
 Decreased or absent peripheral
pulses
Nursing Management
Nursing Diagnoses

 Ineffective tissue perfusion

(peripheral)
 Impaired skin integrity
 Acute pain
 Activity intolerance
 Ineffective therapeutic regimen
management