Arterial Assessment

Front 1

Clinical manifestations of lower extremity disorders: pain

Back 1

Arterial Disorder
 Intermittent claudication
 Rest pain
 Pain may worsen with elevation.

Venous Disorder
 Aching
 Heaviness
 Exercise and elevation may decrease
 Nocturnal cramping
 Heaviness at the end of the day

Front 2

Clinical manifestations: skin

Back 2

Arterial Disorder
 Absence of hair if chronic
 Thin, shiny skin
 Thick toenails if fungal infection is present
 Pale with dependent rubor
 Cool skin

Venous Disorder
 Brown discoloration
 Normal toenails
 Dependent cyanosis
 No change in temperature or may be warmer

Front 3

Dependent rubor --
Dependent Rubor --

Back 3

1. noted in the clients L leg just b4 amputation. Ulceration and necrosis is seen on their third toe.
2. in dark skin where their left foot has a reddish hue as compared with the unaffected right foot.

Front 4

Clinical manifestations: sensation, pulses, and edema

Back 4

Arterial Disorder
 Decreased sensation
 Decreased to absent pulses
 Edema may be present but is usually absent

Venous Disorder
 Pruritis may be present
 Pulses present but difficult to palpate if edematous
 Edema present
 worse at the end of the day, improved with elevation

Front 5

Clinical manifestations: muscle mass and ulcers

Back 5

Arterial Disorder
 Muscle mass is reduced if chronic
 Ulcers
 Small
 Painful
 Points of trauma
 Between toes
 Distal most point
 Lateral malleolus
 Toes

Venous Disorder
 Muscle mass is unaffected in pure venous problems
 Ulcers
 Broad
 Shallow
 Slightly painful ulcers of ankle and lower leg
 Surrounding skin is brown and fibrotic

Front 6

Arterial ulcers of the foot:

Back 6

note pale, hairless appearance of the leg and the smooth, round shape of the ulcers.

Front 7

Intermittent claudication and rest pain

Back 7

Int Clau
 Often cramping pain of the calf
 With ambulation
 Disappears within 1-2 minutes of rest
 Predictable pain for a given distance of walking
 As artery becomes more stenosed

Rest pain
 Distal forefoot burning, tingling
 Control pain with feet below heart level (dependent)

Front 8

Elevation pallor

Back 8

 Elevate foot 12 inches
 Pallor within I minute
 Put in dependent position, color takes more than 10 seconds to return.

** Assess for Elevation Pallor
if arterial insufficiency is suspected.

Front 9

Tests for arterial insufficiency

Back 9

Elevation pallor
ABI - dorsalis pedis and posterial tibial art. doppler probe = check toe pressures -> client. Ankle pressures may be erroneously high = calcification.

1 or more = normal

Ultrasonic duplex scanning
Exercise testing - treadmill

Front 10

CT, MRI, MRA

Back 10

CT: AAA, graft occlusion, hemor, xray
MRI: BF
MRA: BF and visco

Front 11

Angiography

Back 11

 Preoperative or intraoperative
 Performed in a vascular lab with xrays
 Sterile conditions
 Catheter inserted through sheath (introducer)
 Local anesthetic
 Contrast injected
 Fluoroscopy to check catheter position

Front 12

Angiography preprocedure care

Back 12

 Informed consent
 NPO 2-6 hours
 Mild sedative
 Prep femoral site
 Assess renal function, BUN and Creatinine

Front 13

Angiography postprocedure care

Back 13

 Frequent vascular assessment
 Vital signs
 Neurologic function
 Distal pulses, distal color
 Puncture site for hematoma
 Bed rest 6-8 hours
 Affected extremity straight alignment, without flexion
 Crystalloid IV fluid for 6-8 hours to flush out contrast, encourage oral intake
 Check BUN and creatinine levels the next day

Front 14

Angiography postprocedure care (cont'd)

Back 14

Resume all orders, except heparin until hemostasis is evident
 Manage pain with mild analgesics, severe pain may be a hematoma
 Report any vascular changes immediately
 Complications
 Allergy to contrast, thrombi, emboli, artery perforation, renal failure, pseudoaneurysm

Front 15

Vascular endoscopy (angioscopy)

Back 15

 Visualize inside of artery with fiberoptics
 Camera records images, irrigation system
 ID's: Thrombus, plaque, hemorrhage, ulceration, embolus
 Anastomosis
 Can remove debris

Postprocedure care is similar to angiography
 Complications: intimal damage, spasm, thrombosis, embolism, perforation, fluid overload, infection