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Skin Vascular Disease


Presentation

  • Pain that is intermittently present in the foot or leg and occurs with exercise, but is also present at rest, is frequently not related to arterial disease. Other common causes are arthritis or nerve problems (neuropathy).[anzsvs.org.au]
  • , but may be difficult to palpate with edema PAD or PVD: Cap refill 3 secs PAD or PVD: lower leg edema PAD or PVD: Hair may be present PAD or PVD: ulcers are near medial malleolus PAD or PVD: Wound margin is irregularly shaped PAD or PVD: wound drainage[quizlet.com]
  • (%) Specificity (%) LR Abnormal pedal pulse DP and PT pulses absent 0.9 63 99 44.6 PT and DP pulses absent or one absent and one weak 0.9 73 92 9.0 Femoral artery bruit Bruit present 0.8 20 96 4.7 Bruit present 0.9 29 95 5.7 Cool skin Unilateral cooler[aafp.org]
  • On occasion, critical limb ischemia is the only presenting complaint. Segmental blood pressures and pulse volume recordings, particularly the ankle-brachial index ( ABI ), may support the diagnosis.[amboss.com]
  • The level of arterial occlusion present is proportional to the symptoms.[almostadoctor.co.uk]
Foot Ulcer
  • Next we used the same hyaluronic acid hydrogel engineer human microvasculature for the treatment of diabetic foot ulcers (DFUs), one of the leading healthcare problems in the US.[jscholarship.library.jhu.edu]
  • The ulcers may be brown or black, and they're often painful (as opposed to diabetic foot ulcers, which may be painless due to diabetes-related nerve damage).[health.com]
  • It helps prevent wounds or foot ulcers from becoming infected and painful or resulting in gangrene. Good foot care also helps prevent amputation.[msdmanuals.com]
  • […] smooth, looks "punched out" PAD or PVD: Ulcer located on tips of toes, foot, lateral malleolus PAD or PVD: Wound drainage minimal PAD or PVD: Wound tissue is black eschar or pale pink granulation PAD or PVD: Intermittent claudication or rest pain in foot[quizlet.com]
  • Prevent critical artery occlusion that can lead to foot ulcers, gangrene, and amputation. Prevent heart attacks and strokes.[medicinenet.com]

Workup

  • The surgical treatment of systemic manifestations of infection takes immediate priority with the workup of PVD delayed in order to minimize further tissue loss, limb loss or loss of life due to uncontrolled infection.[podiatrytoday.com]
  • The absence of a pulse in the legs or the arms will immediately result in a workup to rule out peripheral vascular disease.[emedicinehealth.com]

Treatment

  • Next we used the same hyaluronic acid hydrogel engineer human microvasculature for the treatment of diabetic foot ulcers (DFUs), one of the leading healthcare problems in the US.[jscholarship.library.jhu.edu]
  • There are many effective treatments available to those who are suffering from CVI that can help to significantly alleviate discomfort while also preventing more serious developments.[skinandvein.com]
  • For the vast majority of people with vasculitis, treatment is very effective.[resources.lupus.org]
  • Treatment Conservative Smoking cessation![amboss.com]

Prognosis

  • Prognosis Intermittent claudication good prognosis Rest pain and/or ischemic ulcers poor prognosis Increased cardiovascular mortality high risk for secondary MI or stroke A low ABI in PAD is also predictive of an increased risk of all-cause and cardiovascular[amboss.com]
  • What is the outlook (prognosis) for peripheral arterial disease? Studies that have followed up people with PAD have shown that: Symptoms remain stable or improve in about 15 out of 20 cases.[patient.info]
  • What is the prognosis for people with vasculitis? There are various outcomes for people with vasculitis. For many people, vasculitis, especially if confined to the skin, may be annoying but never life-threatening.[resources.lupus.org]
  • Expectations (prognosis) The prognosis depends on the underlying disease and the stage at which peripheral vascular disease is discovered. Removal of risk factors, such as smoking, should be done immediately.[rjmatthewsmd.com]
  • Prognosis If PAD is left untreated it does not inevitably lead to amputation.[physio-pedia.com]

Etiology

  • […] cause of ED parallels the etiology of CAD and PVD.[emedicine.medscape.com]
  • Etiology Insufficient tissue perfusion due to atherosclerosis in the aorta and peripheral arteries Often coexists with coronary artery disease ( CAD ), stroke, atrial fibrillation, and renal disease See risk factors for atherosclerosis PAD usually coexists[amboss.com]
  • […] occur after trauma, neurogenic lesions, occlusive arterial disease, connective tissues disease charac. by reduction of blood flow to the fingers manifested by cutaneous vessel constriction and resulting in blanching (pallor) Raynauds’ Disease unknown etiology[slideshare.net]
  • […] aortic PAD was compiled in 2013, combining the 2005 and 2011 guidelines. [34] Prognosis [ edit ] Individuals with PAD have an "exceptionally elevated risk for cardiovascular events and the majority will eventually die of a cardiac or cerebrovascular etiology[en.wikipedia.org]

Epidemiology

  • Peak incidence : 60–80 years of age Sex : References: [1] [2] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • International journal of epidemiology. 1996 Dec 1;25(6):1172-81. Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome.[physio-pedia.com]
  • The pathogenesis and risk factors are the same as for coronary artery disease (CAD), and include: Hypertension Dyslipidaemia High LDL and low LDL levels Diabetes Obesity FH of arterial disease Smoking Age Male gender Epidemiology Affects about 10% of[almostadoctor.co.uk]
  • The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose Questionnaire for use in epidemiological surveys. J Clin Epidemiol. 1992;45:1101–9. 7. O'Hare AM, Glidden DV, Fox CS, Hsu CY.[aafp.org]
  • "Epidemiology, classification, and modifiable risk factors of peripheral arterial disease". Vasc Health Risk Manag. 3 (2): 229–34. doi : 10.2147/vhrm.2007.3.2.229. PMC 1994028. PMID 17580733.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • This is of important pathophysiological significance and may have clinical implications with regard to the role of pharmacological intervention in severe limb ischaemia. Copyright 1999 W.B. Saunders Company Ltd.[ncbi.nlm.nih.gov]
  • Pathophysiology Plaque formation on the intimal wall that causes partial or complete occlusion Calcification of the medial layer and a gradual loss of elasticity  weakens the arterial walls predisposes to aneurysm, dilation or thrombus formation  artery[slideshare.net]
  • Risk Factors Trauma Thrombosis Inflammation Embolism Atherosclerosis Autoimmune response Smoking Pathophysiology Narrowing of the arterial lumen nor damage to the endothelial lining can result from such factors as atherosclerotic buildup of lipid deposits[rnpedia.com]
  • Diabetes and vascular disease: Pathophysiology, clinical consquences and medical therapy. Circulation 2003;108:1527-1532. Selvin E, Wattanakit K, Steffes MW, Coresh J, Sharrett AR.[physio-pedia.com]
  • "Diabetes and vascular disease pathophysiology, clinical consequences, and medical therapy: Part II". Circulation. 108 (13): 1655–1661. doi : 10.1161/01.cir.0000089189.70578.e2. PMID 14517152.[en.wikipedia.org]

Prevention

  • How to Treat your CVI Patients who are experiencing Chronic Venous Insufficiency should seek a vascular surgeon as early as possible to prevent further complications.[skinandvein.com]
  • Nursing Intervention Preventive care prevent long periods of standing or sitting that impair venous return elevate legs when sitting, dorsiflex feet at regular intervals to prevent venous pooling if edema occurs, elevate above heart level regular exercise[slideshare.net]
  • Can I prevent peripheral vascular disease? To prevent PVD, take steps to manage the risk factors.[hopkinsmedicine.org]
  • Preventive Services Task Force (2013). Screening for peripheral arterial disease and cardiovascular disease risk assessment with the ankle-brachial index in adults. U.S. Preventive Services Task Force. . Accessed March 24, 2014.[northshore.org]
  • It helps prevent wounds or foot ulcers from becoming infected and painful or resulting in gangrene. Good foot care also helps prevent amputation.[msdmanuals.com]

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