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Most common causes Vascular Wounds
- Arterial insufficiency
- Venous insufficiency
- Diabetic/neuropathic
- Pressure
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Less common causes vascular wounds
- Connective tissue disorders (RA, SD, SLE)
- Neoplastic disorders (SCC, BCC, lymphoma)
- Hematologic disorders (sickle cell anemia)
- Infections (bacterial, fungal)
- Trauma (arterial or venous)
- Acute embolism
- Diabetes (microvascular disease)
- Hypertension ( blood to peripheral vessels)
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Vascular and Neurologic Tests
- pulse
- cap refill
- girth
- cutaneous sensibility
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Pulse Exam (Myers, Table 4-9)
- 0 = absent pulse
- 1+ = diminished pulse
- 2+ = normal pulse (easily felt)
- 3+ = bounding, aneurysmal
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Capillary Refill
time in seconds (normal < 3 sec)
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Girth
- circumferential measurements
- volumetric measurements
- Cutaneous sensibility
- monofilament testing: 5.07 seems Weinstein filament
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Peripheral Vascular Risk Factors
- Genetic factors
- --- lymphedema
- --- varicose veins
- Smoking
- ---decreased blood flow to extremities
- ---vasospasm
- ---inhibition of prostacyclin formation
- HTN
- ---more prone to atherosclerosis
- Hypercholesterolemia
- ---more prone to atherosclerosis
- Cardiac history
- --- if have atheroscleroris in coronary arteries probably have it in peripheral too
- DM
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Arteriosclerosis Obliterans
- Primary cause of arterial insufficiency
- **Thickening/hardening of arterial walls
- Most common form is atherosclerosis
- Degenerative disease that obstructs blood flow by narrowing arterial lumen
- Collateral circulation is often inadequate
- Intermittent claudication results
- Lack of arterial blood flow leads to formation of arterial ulcers
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Atherosclerosis
- Progresses with age
- Risk factors include:
- ---Smoking
- ---Diabetes mellitus
- ---Hyperlipidemia (elevated LDL)
- ---Hypertension
- ---Trauma
- ---Advanced Age
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Thromboangitis Obliterans (Buerger’s Disease)
- 2nd most common chronic occlusive vascular disease
- **Occurs in young adults who smoke
- Inflammation causes occlusion of both arteries and veins (distal vessels 1st)
- Occlusion can cause tissue ischemia
- **Signs and symptoms: cold sensitivity, ulcers, gangrene of UE and LE’s
- stop smoking/ refer to smoking cessation program
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**Arterial Signs, Symptoms, and Dx
- Pain!!!* (with cool or cold)
- *Cool or cold distal extremities
- *Weak or absent pulses
- Intermittent claudication*
- Ischemia and tissue necrosis *
- *Trophic changes: color changes, slow nail growth, thickened nails, loss of hair, shiny, dry, and flaky skin
- Dx: clinical presentation, ABI, Doppler
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Intermittent Claudication
- One of the 1st signs of arterial insufficiency
- Activity-related pain or discomfort (may be cramping or burning) caused by local ischemia
- At rest, tissue demands for oxygen are met
- Pain distal to site of arterial occlusion
- Obstructed ileofemoral arteries buttock, thigh, calf pain
- Obstructed infrapopliteal arteries foot pain
- Pain abates within 1-5 minutes of rest
- Pain is repeatable and predictable (OBJECTIFY!)
- Treatment: is a walking: ex prescription walking 1 mile per an hour 3-4 times a day for 50ft (increase frequency, not duration/intensity)
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Ischemic Rest Pain
- Pain due to lack of blood supply
- Represents more advanced arterial disease than intermittent claudication
- Described as “burning” pain
- Exacerbated by elevation; relieved by dependency
- Ulcerations usually occur at or beyond this point in the disease process
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Tissue Necrosis
- Ulcerations related to ischemia
- Most commonly result from some sort of trauma to an ischemic limb
- May also result spontaneously from lack of arterial blood supply
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