Peripheral

Vascular

Peripheral Vascular
Disease
SANIYYA AHMED
2nd YEAR M.Sc. NURSING
AMRITA COLLEGE OF NURSING
AIMS / KOCHI

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Peripheral Vascular

Definition
Peripheral vascular disease
( PVD ) is a slow and progressive circulation
disorder caused
by narrowing, blockage, or spasms in a blood
vessel

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Peripheral Vascular

Definition
PVD may involve disease in any of the blood
vessels outside of the heart including the
arteries, veins, or lymphatic vessels

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Peripheral Vascular

Etiology and Risk factors

■ Primarily caused by atherosclerosis
■ Embolism
■ Thrombosis
■ Trauma
■ Vasospasm
■ Obesity

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Peripheral Vascular

Etiology and Risk factors

■ Inflammation
■ Family history
■ Sedentary lifestyle
■ Stress
■ Autoimmunity
■ Smoking
■ Hypertension
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Peripheral Vascular
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 aneurysms, dilation or thrombus formation

Unable to transport adequate blood &O2 to tissues during exercise and rest leading to
appearance of symptoms
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Limb loss and limb
difference

Clinical
Manifestation

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Peripheral Vascular

Types
■ Thromboangiitis obliterans
■ Raynaud's disease
■ Aneurysm
■ Arterial embolism
■ Deep vein thrombosis(DVT)

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Peripheral Vascular

Thromboangiitis obliterans
1. Acute inflammatory lesions and occlusive
thrombosis of the arteries and veins
2. Strong association with smoking
3. Commonly Occurs In Males Between 20-40
yrs

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Peripheral Vascular

Clinical manifestation of
thromboangiitis obliterans
■ Intermittent claudication
■ Pain during rest
■ Coldness
■ Paresthesia

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Peripheral Vascular

Clinical manifestation of
thromboangiitis obliterans
■ Weak or absent pulse in posterior tibial, dorsalis
pedis
■ Extremities are cyanotic
■ Ulceration and gangrene

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Peripheral Vascular

Interventions
■ Advise patient to stop smoking
■ Avoid trauma
■ Emotional support
■ Avoid injuries to feet

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Peripheral Vascular

Interventions
■ Amputation of leg is done only when:
○ Gangrene extends well into foot
○ Pain is severe
○ Severe infection

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Peripheral Vascular

Raynaud’s disease
■ Intermittent episodes during which small
arteries of left or right arm constrict causing
changes in skin color & temperature

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Peripheral Vascular

Raynaud’s disease
■ Symmetric bilateral involvement & may affect
only 1 or 2 fingers
■ May occur after exposure to cold, trauma
■ Characterised by reduction of blood flow to
fingers manifested by pallor

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Peripheral Vascular

Etiology
■ Unknown etiology
■ Common in women may be stimulated by
stress, hypersensitivity to cold

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Peripheral Vascular

Clinical manifestation of
Raynaud’s disease
■ during arterial spasm-sluggish blood flow occurs
■ Following the spasm the area becomes reddened
with tingling & throbbing sensation

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Peripheral Vascular

Clinical manifestation of
Raynaud’s disease
■ With longstanding Raynaud's disease-ulcerations
can develop on fingertips & toes

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Peripheral Vascular

Interventions
■ Prevent injury
■ Provide comfort
■ Avoid smoking
■ Avoid exposure to cold

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Peripheral Vascular

Interventions
■ void drugs that will cause vasoconstriction
■ Suggest anti inflammatory analgesics

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Peripheral Vascular

Aneurysm
■ Is a localized or diffuse enlargement of an
artery at some point along its course
■ Can occur when the vessel becomes weakened
from trauma, congenital vascular disease,
infection or atherosclerosis

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Peripheral Vascular

Types of Aneurysm
■ Saccular Aneurysm- involves only part of the
circumference of the artery
■ Fusiform aneurysm- spindle shaped, involves
the entire circumference of the arterial wall

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Peripheral Vascular

Types of Aneurysm
■ Dissecting Aneurysm- involves hemorrhage
into a vessel wall, splits and dissects the wall
causing widening of the vessel
■ caused by degenerative defect in the tunica
media and tunica intima

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Peripheral Vascular

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

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Peripheral Vascular

Thoracic aortic aneurysm

■ Aneurysm in the thoracic area
■ Can develop in the ascending, transverse or
descending aorta

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Peripheral Vascular

Thoracic aortic aneurysm

Signs
■ Chest pain
■ Cough
■ Dyspnea
■ Hoarseness
■ Dysphagia

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Peripheral Vascular

Abdominal aortic aneurysm

■ Abdominal aorta below the renal arteries
Signs
■ Pulsatile abdominal mass on palpation
■ Pain or tenderness in the mid-or upper
abdomen

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Peripheral Vascular

Abdominal aortic aneurysm

Signs
■ 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

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Peripheral Vascular

Complications
■ Rupture of the aneurysm - most feared
complication
- can occur if the aneurysm is large ( can lead
to death )
- Tx: Surgery - resection of the lesion and
replacement with a graft

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Peripheral Vascular

Arterial Embolism
■ Blood clots floating in the circulating arterial
blood
■ The embolus is frequently a fragment of
arterioschlerotic plaque loosened from the
aorta

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Peripheral Vascular

Arterial Embolism
■ Emboli will tend to lodge in femoral or
popliteal arteries, blood flow is impaired and
ischemia develops

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Peripheral Vascular

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

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Peripheral Vascular

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

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Peripheral Vascular

Deep vein thrombosis ( DVT )

■ Pulmonary embolus - is a serious
complication arising from DVT of the lower
extremities

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Peripheral Vascular

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

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Peripheral Vascular

Clinical Manifestations
■ If superficial veins are affected redness,
warmth, tenderness will occur, the veins feel
hard and thready & sensitive to pressure

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Peripheral Vascular

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

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Peripheral Vascular

Medical management
■ Anticoagulants, initially with VI heparin and
Coumarin
■ Fibrinolytic
■ Vasodilator if needed to control vessel spasm

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Peripheral Vascular

Assessment
■ Condition of the skin: shiny, taut, absence of
hair growth
■ Ulcerations/ necrotic tissues
■ Extremely cold to touch
■ Peripheral pulses: diminished, weak, absent,
bilateral inequality

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Peripheral Vascular

Assessment
■ Grading 0- absent
1+ weak & thready
2+ normal
3+ full & bounding

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Peripheral Vascular

Assessment
■ Prolonged(> 3 secs) or absent capillary refill
of nail beds
■ Loss of muscle tone or weakness

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Peripheral Vascular

Diagnostic evaluation
■ Doppler ultrasonography
■ Ankle brachial index to measure arterial
blood flow
■ Colour flow imaging
■ Transcutaneous Oximetry
■ Angiography

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Peripheral Vascular

Complications
■ Gangrene
■ Extremity amputation
■ Possible infection and sepsis

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Peripheral Vascular

Medical management
■ Weight reduction
■ Exercise
■ Stop smoking
■ Blood lipid reduction
■ Statins, Nicotinic acid, fibric acid derivative,
bile acid resins

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Peripheral Vascular

Medical management
■ Promote arterial flow- Pentoxifylline
■ Cilostazol - vasodilator & anti platelet
■ Trendelenburg position

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Peripheral Vascular

Surgical interventions
■ Embolectomy
■ Endarterectomy is removal of a blood clot
and stripping of atherosclerotic plaque along
with the inner arterial wall

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Peripheral Vascular

Surgical interventions
■ Arterial bypass surgery- an obstructed
arterial segment may be by passed by using a
prosthetic material teflon) or patient's own
artery or vein(saphenous vein)

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Peripheral Vascular

Surgical interventions
■ Percutaneous Transluminal Angioplasty-
the balloon tip of the catheter is inflated to
provide compression of the plaque
■ Amputation

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Peripheral Vascular

Nursing diagnosis
■ Ineffective peripheral tissue perfusion
■ Activity intolerance related to poor blood
flow to the lower extremities

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Peripheral Vascular

Nursing diagnosis
■ Ineffective health maintenance related to
smoking and lack of information about
disease
■ Risk for impaired skin integrity related to
ischemic tissues of legs and feet

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Peripheral Vascular

Foot care for patients with

peripheral atherosclerosis
1. Keep legs & feet clean, dry & comfortable
o Clean with warm water & mild soap
o Pat dry using soft towel
o Apply cream after drying
o Wear a pair of cotton socks everyday

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Peripheral Vascular

Foot care for patients with

peripheral atherosclerosis
2. Prevent accidents and injuries to health
o Always wear shoes
o Walk on ground levels
o Don't go barefoot
o Report if there is any foot problems

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Peripheral Vascular

Foot care for patients with

peripheral atherosclerosis
3. Improve blood supply to legs & feet
o Don't cross legs
o Don't wear knee stockings
o Don't swim in cold water

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Peripheral Vascular

Preventions
■ Do passive exercise of legs
■ Walk for at least 30 mins daily
■ Avoid cold water for bathing
■ Stop smoking
■ if edema occurs, then elevate the legs

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Peripheral Vascular

Preventions
■ Dorsiflex legs at regular intervals to prevent
venous pooling
■ Avoid massaging the affected extremity

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Peripheral Vascular

Preventions
■ Keep extremity warm but do not heat
■ Use elastic stockings on affected leg

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Peripheral Vascular

Health teaching
■ Stop smoking
■ Lose weight
■ Eat low fat diet
■ Avoid walking barefoot

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Peripheral Vascular

Health teaching
■ Begin walking & exercise programme
■ Don't wear restrictive clothing
■ Wear proper fitting shoes

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Peripheral Vascular

Bibliography
1. Casillas JM, Troisgros O, Hannequin A, Gremeaux V, Ader P, Rapin A,
Laurent Y. Rehabilitation in patients with peripheral arterial disease.Ann
Phys Rehabil Med.
2011 Oct;54(7):443-61. English, French. doi:
10.1016/j.rehab.2011.07.001. Epub 2011 Aug .5 PMID: 21917541.
2. Hamburg NM, Balady GJ. Exercise in peripheral artery disease:
functional impact and mechanisms of benefits. Circulation.
2011;123(1):87-97.
do:10.1161/CIRCULATIONAHA.109.881888

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