My lab is focusing more and more on peripheral vascular disease. Are other labs doing this and why are we doing it?
More and more facilities are evaluating and treating peripheral vascular disease in cardiac cath labs. Being more familiar with the anatomy and physiology of PVD would be highly advisable. Among the things we should learn from peripheral artery disease are the importance of assessing PVD and what it means for your patients. There is a direct inverse relationship with the amount of PVD and the length of life. Assessing PVD can help you throughout the time you have with the patient. While you are getting the patient ready for the procedure, check the femoral pulses. How do they feel? Strong and bounding, weak and thready? Can you hear a bruit? Check the anatomy around the pulse, note swelling, the ligament and its location, adipose, color and temperature of the leg and the pedal pulses, if the patient has one. If they do, note its strength. Again, is it full and bounding, weak or absent altogether? If they have one, note its location, mark it if necessary for later evaluation. At the end of the procedure and while you are with the patient, continue to check the leg, the access site and reassess regularly. Watch for changes in color, temperature, appearance and pain the patient may have. Compare it to the leg that was not used for the procedure. All changes from the first or baseline assessment should be noted and the physician informed. If you are not sure, say something anyway. It is better to say something and be wrong than to say nothing at all.
 
How is it that renal artery stenosis causes hypertension?
When the renal artery is blocked, a hormone called renin is produced. Renin secreted from the kidney produces angiotensinogen. Angiotensinogen makes angiotensin I bind to angiotensin II. Angiotensin II makes us retain sodium and fluid, increasing blood pressure. In addition, angiotensin is a vasoconstrictor, increases preload and afterload, and predisposes patients to LVH. Angiotensin Receptor Blockers and Angiotensin Converting Enzyme Inhibitors are used to interrupt this process and relieve the hypertension. Angioplasty of the renal artery can also relieve the hypertension.

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Submit your question to:
Jason Wilson, RCIS
Ellis Hospital Clinical Instructor
Schenectady, New York
hrtfixr7@yahoo.com