ARTERIAL DISORDERS

ARTERIOSCLEROSIS & ATHEROSCLEROSIS

ARTERIOSCLEROSIS
• Is the most common disease of the arteries
• the term means “hardening of the arteries”
• a diffuse process whereby the muscle fibers and the endothelial
lining of the walls of the small arteries and arterioles become
thickened and lose elasticity
• gradually restricts the blood flow to one's organs and tissues
and can lead to severe health risks
ATHEROSCLEROSIS
• affects the intima of the large and medium sized arteries
• build-up of fats, cholesterol and other substances in and
on the artery walls, which can restrict blood flow.
• Accumulations are referred to as atheromas or plaque
» although the pathologic processes of arteriosclerosis and
atherosclerosis differ, rarely does one occur without the other.

Risk factors
Many risk factors are associated with atherosclerosis and atherosclerosis such as:
 Use of tabacco product • Age
 Diet (high fat)
 Hypertention
• Gender
 Diabetes mellitus • Genetics
 Obesity
 Stress
 Sedentary lifestyle
 Elevated C-reactive protien
 Hyperhomocyteinemia
Prevention
 Diet change (decrease fat intake)
 Cessation use of tabacco products

Clinical manifestations:
Clinical signs and symptoms may depend on the organ or tissue
involved:

Heart- chest pain or pressure (angina)

Brain- weak or numb extremities, slurred speech, temporary loss of
vision, drooping face muscles
Extremities- leg pain (claudication)
Kidneys- High blood pressure, kidney failure
Medical management
Management involves modification of risk factors, controlled exercise
programs, medication and surgical graft procedures
Surgical management :
• Inflow procedure, improves blood flow from aorta to femoral
artery
• Outflow procedure, provide blood supply to vessels below the
femoral artery
Radiologic interventions:
• Percutaneous transluminal angioplasty, cracks and flattens plaque.
• Stent insertion, decreases risk of reocclusion
Nursing management
• Improving peripheral arterial circulation
• Promoting vasodilation and preventing vascular
compression
• Relieving pain
• Maintaining tissue integrity
• Promoting home and community based care
AORTOLIAC DISEASE
• also called aortoiliac occlusive disease
• disorders of the two major blood vessels that feed the lower half of the
body, aortic and iliac artery

Risk factors:
The primary cause of aortoliac disease is atherosclerosis.
 Use of tabacco product
 Diet (high fat)
 Obesity
 Hypertension
 Family history of cardiovascular disease

Medical manifestations
Patients may feel buttocks or lower back discomfort, may have weak or absent
femoral pulse. men may also expirience impotence, some patients may be
asymptomatic
Medical management
• Aortoiliac graft
• Aortobifemoral graft

Nursing management
• Assessment of pulses
• Patient education
• Monitoring signs of thrombosis
• Assessment of extremities(color, temperature, capillary refill,
sensory and motor function)
• Monitoring intake and output
• Monitoring lab results
Aneurysms
Is a excessive localized enlargement, sac or dilatation formed at a weak
point in the wall of the artery. An aneurysm can be characterized by its
location, shape, and cause.

Forms of aneurysms:
• Fusiform - bulges or balloons out on all sides of the blood vessel.
• Saccular - bulges or balloons out only on one side.
• Pseudoaneurysm - or false aneurysm, is not an enlargement of any of the
layers of the blood vessel wall, blood fills in between the layers of the blood
vessel wall creating a pseudoaneurysm
• Dissecting - occurs with a tear in the artery wall that separates the 3
layers of the wall, rather than ballooning out the entire wall
Etiological classifications of arterial aneurysms
Congenital – caused by connective tissue disorders and other diseases
Mechanical (hemodynamic) – poststenotic and arteriovenous fistula and amputation
related
Traumatic (pseudoaneurysms) – penatrative arterial injuries and blunt arterial injuries
Inflammatory (noninfectious) – associated with arteritis and periarterial inflammation
Infectious (mycotic) – bacterial, fungal and spirochetal infections
Anastomotic (postarteriotomy) and graft aneurysms – infection, arterial wall failure,
graft failure
Thoracic aortic aneurysms
• occurs in the part of the body's largest artery (the aorta) that passes through the
chest.
• Most cases are caused by atherosclerosis
• This condition is more common in people with high cholesterol, long-term
high blood pressure, or who smoke. But happen more frequently in men
between the ages of 40 and 70 years.

Clinical manifestations:
Some patients are asymptomatic but in most cases:
• Pain while supine
• Dyspnea
• Brassy cough
• Hoarseness , stridor or complete loss of voice
• Dysphagia
Medical management
• Controlling blood pressure and correcting risk
• Medications such as; beta-blockers, antihypertensives and sodium
nitroprusside
• Surgeries with a vascular graft, repair the aneurysms and restore vascular
continuity
• Cerebral spinal drainage, improving spinal perfusion
Abdominal aortic aneurysm
• a blood-filled bulge or ballooning in a part of the aorta that runs through the
abdomen.
• This condition is more common in people with high cholesterol, long-term
high blood pressure, or who smoke. Common among Caucasians, affects
men four times more often than women and is most prevalent in elderly
patients
• Most cases occur in patients between 60 and 90 years old
• doctors believe that this may be due to clogged arteries (atherosclerosis), but
it may also be related to heredity, injury, or other diseases.

Clinical manifestations:
Most people with an abdominal aortic aneurysm do not have any
symptoms(60%) Often, the aneurysms grow slowly and go unnoticed.
• throbbing in the middle or lower part of the stomach
• lower back pain
•  tenderness of the chest
Medical management
• Pharmacologic therapy, antihypertensives (diuretics, bet-
blockers, ACE inhibitors) are used to maintain the patients
blood pressure within acceptable limits
• Surgical management, standard treatment has been open surgical
repair of the aneurysm is by placing a bypass graft or by
endovascular grafting.

Nursing management:
• Organ function assessment
• Assessment of pain (abdominal or lower back pain)
• Monitor blood pressure and blood levels
• Monitor pulmonary, cardiovascular, renal, and neurologic status
• Assess for signs of infections and other complications
Other aneurysms
Aneurysms may also arise in the peripheral vessels, most often
as a result of atherosclerosis. These may involve such vessels such as

• Subclavian artery
• Renal artery
• Femoral artery or
• (most frequently) popliteal artery

Between 50% and 60% of popliteal aneurysms are bilateral and

may be associated with abdominal aortic aneurysms.

Diagnosis is made by a duplex ultrasonography and CTA.

Arteriography may be performed.
Medical Management

Surgical repair is performed with replacement grafts or

endovascular repair using a stent-graft or wall graft, which is
a Dacron or PTEE graft with external structures made from a
variety of materials (eg. Nitrinol, titanium, stainless steel) for
additional support.
Nursing Management

• (endovascular repair) lie supine for 6 hours; the head of

the bed may be elevated up to 45 degrees after 2 hours
• Use a bedpan or urinal while on bed rest, or an indwelling
urinary catheter
• V/S and Doppler assessment of peripheral pulses are
performed initially every 15 minutes
• (Access site) Assess for bleeding , pulsation and swelling,
pain and hematoma formation.
• Skin changes of the lower extremity, lumbar area, or
buttocks that may indicate signs of embolization are
immediately reported to the physician.
Dissecting Aorta

Occasionally, in an aorta diseased by arteriosclerosis, a tear

develops in the intima or the media degenerates, resulting in a
dissection.

Pathophysiology

Arterial dissections (separation) are commonly associated with

poorly controlled hypertension, blunt chest trauma and cocaine use.
Increase in sympathetic response caused by cocaine use creates an
increase in the force of left ventricular contraction that causes
heightened shear forces upon the aortic wall. Rupture in the intimal
layer causing dissection allowing blood to re enter the main channel
and resulting in chronic dissection or occlusion of the aorta.
CLINICAL MANIFESTATIONS
• Severe and persistent pain (tearing or ripping)
• Pain is in the anterior chest or back and extends to the
shoulders, epigastric area or abdomen
• Patient may appear pale.
• Sweating and tachycardia may be detected
• Blood pressure may be elevated or different from one
arm to the other
ASSESSMENT and DIAGNOSTIC FINDINGS
• Arteriography
• CTA (computed tomography angiography)
• Transesophageal echocardiography
• Duplex ultrasonography
• MRA aid in the diagnosis
MEDICAL AND NURSING MANAGEMENT
MANANGEMENT

• The medical and surgical tx depends on the type of

dissection present and follows the general principles
outlined for the treatment of thoracic aortic aneurysms.
Arterial Embolism and
Arterial Thrombosis
• Acute vascular occlusion may be caused by an embolus or
acute thrombosis.
• Arterial emboli arise most commonly from thrombi that
develop in the chambers of the heart as a result of atrial
fibrillation, myocardial infarction, ineffective endocarditis, or
chronic heart failure.
• Thrombi become detached and are carried from the left side
of the heart into arterial system, where they lodge in and
obstruct an artery that is smaller than the embolus.
 Clinical Manifestations
• Cessation of distal blood flow
• Severe pain
• Gradual loss of sensory and motor function

6P’s
• Pain
• Pallor
• Pulselessness
• Paresthesia
• Poikilothermia
• Paralysis
 Assessment & Diagnostic
• Two-dimensional transthoracic echocardiography (TEE)
• Chest x-ray
• Electrocardiography (ECG)
Medical Management
• Heparin therapy
• IV bolus of 5000 units or 60 units/kg
Surgical Management
• Emergency embolectomy
Endovascular
Management

• Percutaneous mech
• anical thrombectomy devices