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VASCULAR DISORDERS

Muthuukaruppan M.

Thromboangiitis Obliterans
• Nonatherosclerotic vascular disease, characterized by minimal presence of atheromas, segmental vascular inflammation, vasoocclusive phenomenon involving small & medium sized arteries & veins of upper & lower extremities. • Associated with tobacco use and exposure is the cause for initiation and progression. • Disease mechanism is unclear, an immunologic phenomenon that leads to vasodysfunction and inflammatory thrombi.

• Common in males between 20 – 45 years. Bangladesh. pain at rest. exclusion of autoimmune disease and source of emboli. Japan and in few races in Israel. • Common in India. have serum anti-endothelial cell antibody titers and have impaired peripheral vasculature endothelium-dependent vasorelaxation. ischemic ulcers or gangrene). • Diagnostic criteria are: younger than 45yrs. . presence of distal extremity ischemia (claudication. current history of tobacco use.• Increased cellular sensitivity to types I & III collagen. Korea.

legs. • Foot infections are common in later stages • Arteries of extremities are common but rarely proximal arteries are also seen.• 70-80% patients present with Buerger disease with distal ischemic rest pain and/or ischemic ulcerations on the toes. feet or fingers. hands or arms and sensitivity to cold. . • Paresthesias of feet and hands and impaired distal pulses. • Involvement of large arteries are unusual • Claudication of feet.

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• Use of protective garments. • Arteriography / angiography are done. avoidance of cold environments and drugs that lead to vasoconstriction. • Intravenous iloprost an prostaglandin analogue • Thrombolytic therapy is being under experimentation. . • Absolute discontinuation of tobacco is the only proven strategy.• Allen’s test is used to check the integrity of blood refill in the arteries. treatment against infections.

. • Raynaud’s phenomenon is classified as primary and secondary. • Raynaud’s phenomenon was described to be episodic. symmetric. • Primary presents with vasospasm alone with no association with another illness. cyanosis and sense of fullness or tautness which may be painful.Raynaud’s disease • Recurrent vasospasm of the fingers and toes in response to stress or cold exposure. vasospasm with pallor.

leading to tissue hypoxia.95%) and mixed connective disorders.• Secondary Raynaud’s phenomenon presents with vasospasm associated with another illness mostly autoimmune disease. • Associated with autoimmune diseases like progressive systemic sclerosis (Scleroderma. • Hyper-activation of the sympathetic nervous system causing vasoconstriction of the peripheral blood vessels. . • Young female patients with Raynaud’s phenomenon alone for more than 2 years are at low risk than older patients and males with Raynaud’s phenomenon.

industrial exposure to PVC. • Episodic and when the episode subsides or area is warmed. the blood flow returns and accompanied by swelling. . solvents like xylene. pallor and sensations of cold and numbness.• Presents with pain within the affected extremities. tingling and pain. • Deficiency of a vasodilatory mediators. endothelin-1 a potent vasoconstrictor found to be circulating in high levels and some have identified that habituation to stressful stimuli is reduced. acetone and chlorinated solvents. nitric oxide. • Related to occupations such as jackhammers.

• Warming of local body part. • Flexibility exercises. • Goals of Physiotherapy are to maintain independence of function. breathing control. ROM and muscle power. stretching. . • Cervical & digital sympathectomy are surgical approaches. cessation of nicotine reduces the symptoms. lung function. • Calcium channel blockers and prostacyclin analogue are preferred. hydrotherapy with cautious temperature and thermotherapy before exercises are beneficial.

Deep Vein Thrmobosis • Venous thromboembolism is a presentation of DVT • Development of venous thrombosis may be due to venous stasis. activation of blood coagulation and vein damage. • Other causes may be due to reduced blood flow from increased blood viscosity. . • Frequent causes for venous stasis are immobilization or central venous obstruction. anatomic variants and mechanical injury to vein.

older than 75yrs. stroke. polycythemia. • Primary management objectives are to prevent pulmonary embolism and prevent or minimize developing post thrombotic syndrome. pregnancy and postpartum period. tenderness and fullness in skin texture. cancer. whereas cyanosis and ischemia is rare.• Common risk factors for DVT are presence of acute infectious disease. limb edema. • Pain. surgery and immobilization more than 3 days. obesity. long plane or car trips > 4hrs. SCI. thrombocytosis. Burns. history of prior DVT. CHF. • Anti-coagulant therapy and thrombolytics is the main stay. .

pneumatic compression devices and compression garments are encouraged. with the known risk factors active limb movement. Active movements are preferred than any passive mobilization.• Prevention is the primary management of DVT. . • Post DVT physical therapy is contraindicated or ensued with caution. early immobilization.

• Appearance of spider veins. ankle swelling in evening and brownish yellow skin discolouration near the affected veins.Varicose Veins • Veins that have become enlarged and tortuous. • Most common in the superficial veins of the legs when forced to high pressures in long standing. • Veins while losing the elasticity or valve functions become varicose and enlarge. . • Varicose veins can be painful and heavy after exercise or at night.

Skin changes: pigmentation. • Minor injuries may bleed more than normal and may present with restless leg syndrome. Skin changes with active ulcers . eczema 6. Varicose veins 4. No visible or palpable signs of venous disease 2. Stages: 1. Telangectasia or reticular veins 3. Edema 5.• Venous dermatitis or eczema. 5 and 6 but with healed ulcers 8. cramps develop. Skin changes: lipodermatosclerosis 7.

Management: • Elevating limbs are for temporary symptomatic relief. leg injury and abdominal straining. • Compression stockings. prolonged standing. obesity. • Endovenous thermal ablation. aging. intermittent pneumatic compression devices.• More common in women. • Pharmacologic management with antiinflammatory and flavonoids. sclerotherapy • Phlebectomy and vein ligation . menopause. factors are pregnancy.

• Avoiding long standing and compression garments. • Pain relief and edema management are the realms of physiotherapy.• Physiotherapy management involves prevention and symptomatic management. .

Physiotherapy in respiratory care.). Tidy’s Physiotherapy. .). 4. Elizabeth Dean(2005). Jennifer Pryor.References 1. Churchill Livingstone 3. Cardiovascular & pulmonary physical therapy. porter (2003).). Mosby 2. Stuart B. Physiotherapy for respiratory and cardiac problems. Webber (2005). Barbara A. Donna Frownfelter. (4th ed. Alexandra Hough (2001). (3rd ed. Churchill Livingstone. (2nd ed. (14th ed.). Nelson Thornes.

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