1. Presented by TaSheva Davis, BSN, RN Peripheral Arterial Disease

2. Peripheral Artery Disease Atherosclerotic disease of the arteries that perfuse the limbs, especially the lower extremities Blockage causes pain, loss of pulses & changes in extremities Experience pain with ambulation due to intermittent claudication Difficult to do ADL’s (Walking long distances) Estimated 12 million people in United States

3. PAD  Common cause is Atherosclerosis  Cholesterol-plague buildup  Associated with Coronary Artery Disease A. Age B. Gender C. Race D. Diabetes E. Smoking F. Hypertension G. Hyperlipidemia

4. PERIPHERAL ARTERY DISEASE Lower extremity pain- Intermittent claudication Hair loss Cool extremities Poorly palpable pulses Muscular pain in legs Pallor Rubor: onset of erythema after 15 seconds of sitting upright after leg elevation

5. Peripheral Artery Disease Claudication Ischemic rest pain Ischemic ulcerations Smaller calf muscles High rate of depression Limb loss Revascularizations Repeated Hospitalizations MI, Stroke High Mortality Rate

6. PAD Diagnostic Test: ABI (Ankle Brachial Index) ABI Testing: use hand held Doppler measure posterior tibial in each leg take highest systolic pressure and compare to the highest brachial pressure from the arms Normal ABI is 0.90 to 1.40 Cardiovascular Exam Blood pressure (20mm Hg difference) Bruits Abdominal Aorta palpated Tibial pulses

7. CILOSTAZOL Phosphodiesterase type 3 inhibitor suppresses platelet aggregation and is a direct arterial vasodilator Administer 100mg po BID No side effects with anticoagulants and antiplatelet medication FDA approved Increases peak walking time by 35-41% Improves walking distances and quality of life

8. GINKGO BILOBA Extract from the leaves of the ginkgo tree with toxic ginkgolic acid removed Stimulate prostaglandin synthesis causing vasodilation increasing tissue perfusion Negative reaction when taken with anticoagulants and antiplatelet Taken 120mg po BID Affects claudication but will not increase walking distance

9. Patient Education Provide information about PAD Smoking Cessation Diet/Weight Management Encourage exercise Take prescribed medications Target cholesterol levels Monitor Diabetes Warren, E., (2013). Ten things the practice nurse can do about peripheral arterial disease. Practice Nurse. 43(12), 148.

10. Peripheral Artery Disease Atherosclerotic Disease Lower extremity pain due to intermittent claudication ABI testing to determine severity Cilostazol Educate on management of disease

11. References Arian, F.A., & Copper, L.T. (2008). Peripheral arterial disease: Diagnosis and management. Mayo Clinic Proceedings. 83(8), 944-950. Gardner, A.W., & Ritt-Dias, R.M., & Khurana, A., & Parker, D.E. (2010). Daily ambulatory activity monitoring in patients with peripheral artery disease. Physical therapy Reviews. 15(3), 212-222. doi 10.1179/174328810X12814016178917 Hennion, D.R., & Siano, K.A. (2013). Diagnosis and treatment of peripheral arterial disease. American Academy of Family Physicians. 88(5), 306-310. McCance, K.L., & Heuther, S.E., & Brashers, V.L., & Rote, N.S. (2010). Pathophysiology the biologic basis for disease in adults and children. (6 th Ed. P 1160). Mosby. Olin, J.W., & Sealove, B.A. (2010). Peripheral artery disease: Current insight to into the disease and its diagnosis and management. Mayo Clinic Proceedings. 85(7), 678-688. Doi 10.4065/mcp.2010.0133 Woo, T.M., & Wynne, A.L. (2011). Herbal and complementary therapies. In F. McPherson. (3 rd Ed.), Pharmacotherapeutics for Nurse Practitioner prescribers. (pp 103-113). F.A. Davis.