PERIPHERAL VASCULAR DISEASE

• PVD refers to diseases of the blood vessels

(arteries and veins) located outside the heart
and brain.
• Also known as peripheral arterial disease, PAD
a condition that develops when the arteries
that supply blood to the internal organs, arms,
and legs become completely or partially
blocked as a result of atherosclerosis.
• Definition
– Peripheral vascular disease (PVD) is a slow and
progressive circulation disorder caused by
narrowing, blockage or spasms in a blood vessel
PVD may involve disease in any of the blood
vessels outside of the heart including the arteries,
veins, or lymphatic vessels
 ETIOLOGY AND RISK FACTORS
• Primarily caused by
– atherosclerosis
– Embolism
– Thrombosis
– Trauma
– Vasospasm
– Inflammation
– Family history
– Sedentary lifestyle
– Stress
– Autoimmunity
– Smoking
– Hypertension
– obesity
 Pathophysiology
• Risk factors ↑ Blood cholesterol Plaque
formation on intimal wall that causes partial
or complete occlusion Calcification of medial
layer and gradual loss of elasticity Weakening
of arterial wall Predisposes to aneuryms,
dilation or thrombus formation Unable to
transport adequate blood & O₂ to tissues
during exercise and rest leading to appearance
of symptoms
 TYPES
• Thromboangitis obliterans
• Raynauds disease
• Aneurysm
• Arterial embolism
• Deep vein thrombosis(DVT)
 Thromboangitis obliterans
• Acute inflammatory lesions and occlusive
thrombosis of the arteries and veins
• Strong association with smoking
• Commonly occurs in male between 20-40yrs
 CLINICAL MANIFESTATIONS
• Intermittent claudication
• Pain during rest
• Coldness
• Paresthesia
• Weak or absent pulse in posterior tibial,
dorsalis pedis
• Extremities are cyanotic
• Ulceration and gangrene
 INTERVENTIONS
• Advise patient to stop smoking
• Avoid trauma
• Emotional support
• Avoid injuries to feet
• Amputation of leg is done only when Gangrene
extends well into foot /Pain is severe /Severe
infection
 RAYNAUDS DISEASE
• Intermittent episodes during which small
arteries of left or right arm constrict causing
changes in skin color & temperature
Symmetric bilateral involvement & may affect
only 1or 2 fingers May occur after exposure to
cold, trauma Characterised by reduction of
blood flow to fingers manifested by pallor
 ETIOLOGY
• Unknown etiology
• Common in women may be stimulated by
stress, hypersensitivity to cold
 CLINICAL MANIFESTATIONS OF RAYNAUDS
DISEASE
• During arterial spasm-sluggish blood flow
occurs Following the spasm the area becomes
reddened with tingling & throbbing sensation
With long standing raynaud’s disease-
ulcerations can develop on fingertips & toes
 INTERVENTIONS
• Prevent injury
• Provide comfort
• Avoid smoking
• Avoid exposure to cold Wear warm clothing,
gloves & socks
• Avoid drugs that will cause vasoconstriction
• Suggest anti inflammatory analgesics
 ANEURYSM
• It Is a localized or diffuse enlargement of an
artery at some point along its course it Can
occur when the vessel becomes weakened
from trauma, congenital vascular disease,
infection or atherosclerosis
 TYPES OF ANEURYSM

• Secular aneurysm – involves only part of the

circumference of the artery
• Fusiform aneurysm – spindle shaped, involves
the entire circumference of the arterial wall
• Dissecting aneurysm – involves hemorrhage
into a vessel wall, which splits and dissects the
wall causing a widening of the vessel caused by
degenerative defect in the tunica media and
tunica intima
 DIAGNOSTIC TESTS
• CHEST & ABDOMINAL X-RAYS – helpful in
preliminary diagnosis of aortic aneurysm

• ULTRASOUND – is useful in determining the

size, shape and location of the aneurysm

• CT & MRA
 THORACIC AORTIC ANEURYSM
• Aneurysm in the thoracic area Can develop in
the ascending, transverse or descending aorta
– Chest pain
– Cough
– Dyspnea
– Hoarseness
– Dysphagia
 ABDOMINAL AORTIC ANEURYSM
• Abdominal aorta below the renal arteries
• Pulsatile abdominal mass on palpation
• Pain or tenderness in the mid-or upper
abdomen
• The aneurysm may extend to impinge on the
renal, iliac, or mesenteric arteries
• Stasis of blood favors thrombus formation
along the wall of the vessel
 COMPLICATIONS
• Rupture of the aneurysm – most feared
complication can occur if the aneurysm is
large and it can lead to death

• Tx: Surgery – resection of the lesion and

replacement with a graft
 Arterial Embolism
• Blood clots floating in the circulating arterial
blood
• The embolus is frequently a fragment of
arteriosclerotic plaque loosened from the
aorta
• Emboli will tend to lodge in femoral or
popliteal arteries, blood flow is impaired and
ischemia develops
 CLINICAL MANIFESTATIONS

• Abrupt onset of severe pain

• Muscular weakness and burning, aching pain
• Distal pulses are absent and extremity
becomes cold, numb and pale
• Symptoms of shock may develop
 DEEP VEIN THROMBOSIS (DVT)
• Tends to occur at the deep veins due to stasis of
blood
• A major risk during the acute phase of
thrombophlebitis is dislodgment of the thrombus
• Pulmonary embolus – is a serious complication
arising from DVT of the lower extremities
 CLINICAL MANIFESTATIONS

– Pain and edema of extremity

– (+) Homan’s sign
• Do not check for the Homan’s sign if DVT is already
known to be present risk of embolus formation
– If superficial veins are affected redness, warmth,
tenderness will occur, the veins feel hard and
thread & sensitive to pressure
 MEDICAL MANAGEMENT
• Requires hospitalization
• Bed rest with legs elevated to 15-20 degrees
• Application of warm moist heat to reduce pain
• Elastic stocking or bandage
• Anticoagulants, initially with IV heparin then
Coumarin
• Vasodilator if needed to control vessel spasm
 Prevention &management of DVT
• Encourage patient mobility and physical activity at the
individual and institutional level.
• Recommend/use mechanical compression for
individuals at moderate or high risk for DVT
• Consult with the physician about medication for
individuals at moderate or high risk for DVT
• Provide education on DVT prevention (leg exercises,
ambulation, hydration, etc)
• Provide education on the risk factors, signs and
symptoms, and consequences of DVT
• Engage patients with known DVT in safe mobilization.
• Recommend/use mechanical compression.
• Provide education on the risks and benefits of
mobilization following DVT.
• Patient education should be given throughout the DVT
prevention and management process.
• Patients should have the autonomy to decide if they
want to engage in recommended prevention and
treatment measures.
•
• Acute care explain purpose of bed rest and leg elevation
• use elastic stockings
• monitor pt. on anticoagulant & fibrinolytic therapy for
signs of bleeding
• monitor for signs of pulmonary embolism – sudden onset
of chest pain, dyspnea, rapid breathing, tachycardia
• avoid rubbing or massaging the affected extremity
• give analgesic and anti-inflammatory agents to promote
comfort
 Varicose Veins
• They are abnormally dilated veins with incompetent valves, occurring
most often in the lower extremities usually affected are woman 30-50
years old.

• Causes :
– congenital absence of a valve
– incompetent valves due to external pressure on the veins from pregnancy,
ascites or abdominal tumors
– sustained in venous pressure due to CHF, cirrhosis
• Prevention
– wear elastic stockings during activities that require long standing or when
pregnant
– moderate exercise, elevation of legs
• Trendelenburg test assess competency of venous
valves through measurement of venous filling time
the pt.
• lies down with the affected leg raised to allow for
venous emptying a tourniquet is then applied above
the knee and the pt. stands.
• The direction and filling time are recorded both
before & after the tourniquet is removed
Incompetent valves are evident when the veins fill
rapidly from backward blood flow
 LYMPHOEDEMA

• Lymphoedema occurs when the lymphatic are

unable to remove protein-rich fluid from the
tissues.
• Normally, protein passes through the walls of
the arterioles and fluid is re-absorbed into the
venules
 Physiotherapy treatment
• Heat or Cold therapy
– Extreme heat or cold therapy is usually contra-
indicated in peripheral arterial disease, since
sensation is commonly impaired, the vascular
response is obviously abnormal, and the skin
devitalised.
– contrast bathing with warm and cool water may
be helpful.