Peripheral Arterial Disease Case Study
Thank you for your detailed illustration of peripheral arterial disease (PAD). The point of view that I will be sharing with you is the postoperative intervention and rehabilitation of PAD in the acute care setting. Mahameed (2009) describes the indication for invasive revascularization surgery in individuals who failed conservative claudication therapies; acute or critical limb ischemia and lifestyle-limiting claudication.
The surgical procedures that are most commonly performed are carotid endarterectomy and lower extremities bypass grafting. Postoperatively, the vascular surgeon refers these patients to physical therapy for early ambulation training. As a physical therapist, thorough physical assessment including vital signs is necessary; especially blood pressure determination to assure that the bypass graft is getting enough perfusion. Low BP reading can result in low blood flow to the graft site; conversely, high BP can damage the graft due to elevated pressure.
Equally important, assessing the skin color, temperature and the pulse of the surgical limb by using a Doppler ultrasound and report findings to the bedside nurse
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Hence, a physical therapist must assure proper fall prevention teaching and strategies are implemented such as using an appropriate assistive device for ambulation. In addition to ambulation, supervised LE range of motion exercises (ROM) and gentle strengthening activities must be performed. These patients are prone to develop hip/knee flexion contractures due to immobility, post-operative pain, and fear of moving the surgical part. Nicolai, Teijink, & Prins (2010, p. 353) acknowledges the importance of supervised exercise therapy (SET) for patients with intermittent claudication (IC) vs. solely walking information alone in improving ambulation distance; the researchers found that SET is an effective treatment for IC and should be given as first-line
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