PERIPHERAL ARTERIAL DISEASE (PAD)

PAD is a circulatory disorder characterized by the build-up of atherosclerotic plaques on the interior surface of arteries. These plaques harden and impede blood flow to the periphery.

Claudication- Cramping triggered or exacerbated by exertion and relieved by rest.

Common complaints 

Claudication
Delayed wound healing
“reddish-blue” color to extremities

 

    Acute onset of symptoms more indicative of embolism obstructing blood flow and requires emergent intervention

Physical Examination 

Consider using the 6 “P”s Method
Pain, pulselessness, paresthesia, paralysis, poikilothermia (coolness) and pallor

Trick to differentiate PAD from chronic venous insufficiency

Raise patient’s legs for several minutes, when legs are dependent again 

• Patient with PAD will have pale, dusky red extremities
• Patient with chronic venous insufficiency will have improved color in the extremities

Diagnostic tests

• Doppler flow studies 
• Ankle-Brachial Index (ABI)

Pharmacologic Interventions 

The goal of therapy is the prevention of thromboembolism.
Consider using: 

For claudication management- Trental (pentoxifylline)
For antiplatelet prophylaxis- Aspirin 81mg PO daily

References
Dunphy, L.M., Winland-Brown, J.E., Porter, B.O. & Thomas, D.J. (2015). Primary Care: The Art and Science of Advanced Practice Nursing, 4th Edition, Philadelphia: F.A. Davis Company