Vascular Disorders and Peripheral Circul

Vascular Disorders and Peripheral Circulation Problems : 

Vascular Disorders and Peripheral Circulation Problems Chapter 31

Peripheral Vascular Disease : 

Peripheral Vascular Disease Includes disorders that alter the natural flow of blood thorough the arteries and veins of the peripheral circulation. Lower extremities affected more often than upper. Peripheral Arterial Disease (PAD) Most common Peripheral Venous Disease

Peripheral Arterial Disease : 

Peripheral Arterial Disease A common circulatory problem in which narrowed arteries reduce blood flow to your limbs Deprives lower extremities of oxygen and nutrients (causes intermittent claudication) Atherosclerosis is most common cause

Peripheral Arterial Disease : 

Peripheral Arterial Disease Clinical Manifestations Intermittent claudication Rest pain (late stages) Cold or numb sensation in the extremities Smooth, shiny, dry skin, no hair Thickened toenails Cyanotic or darkened extremity Pallor when extremity ↑ (don’t inc. above heart) Diminished/absent peripheral pulses Small, circular, deep, painful ulcers over bony prominences

Peripheral Arterial Disease : 

Peripheral Arterial Disease Diagnostic Evaluation Segmental systolic blood pressure measurements CW doppler with ABIs Exercise tolerance testing Duplex ultrasonography Angiography

Medical Management : 

Medical Management Pentoxifylline (Trental) and cilostazol (Pletal) Use of antiplatelet agents Exercise program Surgical management Endarterectomy Bypass Graft ANGIOPLASTY

Clinical Situation : 

Clinical Situation Mr. Smith had a left fem-pop bypass 12 hours ago. You have been monitoring VS and circulation per post-op protocol. It is now time for the next hourly check. His blood pressure has dropped to 90 mm HG and his heart rate has increased to 112. The left foot is cool and pale. He complains of a sudden increase in pain. On assessment you can not palpate the left pedal pulse. What do you think has occurred? Prioritize your actions?

Buerger’s Disease: Thromboangiitis Obliterans : 

Buerger’s Disease: Thromboangiitis Obliterans Recurring inflammatory process of the small and intermediate vessels of (usually) the lower extremities; probably an autoimmune disorder (results in occlusion of the vessels) Most often occurs in men ages 20-35 who are heavy smokers Progressive occlusion of vessels results in pain, ischemic changes, ulcerations, and gangrene.

Buerger’s Disease: Thromboangiitis Obliterans : 

Buerger’s Disease: Thromboangiitis Obliterans

Aneurysms : 

Aneurysms Permanent localized dilation of an artery; a balloon-like bulge in an artery Types Abdominal aortic aneurysms (AAA) Thoracic aortic Etiology Atherosclerosis Hypertension Cigarette smoking Genetic predisposition

Thoracic Aortic Aneurysm : 

Thoracic Aortic Aneurysm Most common site for a dissecting aneurysm Back pain and manifestation of compression of adjacent structures SOB, hoarseness, difficulty swallowing Sudden excruciating back or chest pain is symptomatic of thoracic rupture

Abdominal Aortic Aneurysm : 

Abdominal Aortic Aneurysm Often asymptomatic Common sites of pain: Abdomen, flank, back Detectable signs: Pulsating mass in the middle/upper abd Bruit over mass Signs of impending rupture: Sudden onset of severe pain in back or lower abdomen radiating to groin, buttocks, or legs

Abdominal Aortic Aneurysm : 

Abdominal Aortic Aneurysm Radiographic Assessment Abdominal xray or lateral film of the spine will often identify aneurysm CT scan is standard tool Ultrasonography

Abdominal Aortic Aneurysm : 

Abdominal Aortic Aneurysm Interventions Non-surgical Monitor growth of aneurysm and maintain blood pressure at normal level to ↓ risk of rupture Surgical May be elective or emergency

Aortic Dissection : 

Aortic Dissection Inner layer (lining) of the aortic wall tears. Sudden Pain: tearing, ripping, and stabbing Nonsurgical treatment Surgical treatment

Acute Peripheral Arterial Occlusion : 

Acute Peripheral Arterial Occlusion Embolus is most common cause Most originate from heart post MI or afib Most common in lower extremities Assessment: “Six P’s” of ischemia Pain, pallor, pulselessness Paresthesia, paralysis, poikilothermia (coldness)

Acute Peripheral Arterial Occlusion : 

Acute Peripheral Arterial Occlusion Interventions: Anticoagulant therapy IV: Heparin Surgical thrombectomy/embolectomy Intra-arterial thrombolytics and platelet inhibitors

Raynaud’s Disease : 

Raynaud’s Disease Arteriole vasoconstriction that results in coldness, pain, and pallor of the fingertips or toes Cause is unknown Episodes may be triggered by emotional factors or by unusual sensitivity to cold Avoid the stimuli May be treated with calcium channel blockers

Peripheral Venous Disease : 

Peripheral Venous Disease Alteration of blood flow in veins Chronic venous insufficiency (CVI) Varicose veins produced by CVI May require ligation and stripping, ablation, sclerotherapy DVT

Peripheral Venous Disease : 

Peripheral Venous Disease Clinical Manifestations Normal pulses Brown patches of discoloration on lower legs Dependent edema; swelling Irregularly shaped, usually painless ulcers on lower legs and ankles Dependent cyanosis and pain Pain relief when legs elevated No intermittent claudication Normal nails

Deep Vein Thrombosis : 

Deep Vein Thrombosis Assessment May be asymptomatic Classic s/s: calf or groin tenderness or pain, Sudden onset of unilateral swelling, + Homen’s sign What diagnostics would you expect to be ordered?

Deep Vein Thrombosis : 

Deep Vein Thrombosis Interventions Non-surgical management Bedrest Elevation of extremity for pain relief Monitor for s/s of pulmonary embolus Compression stockings Drug therapy Heparin Coumadin Thrombolytic therapy Surgical management Thrombectomy Vena Cava filter (Greenfield filter)

Arterial or Venous Insufficiency?? : 

Arterial or Venous Insufficiency??

Arterial or Venous Insufficiency? : 

Arterial or Venous Insufficiency?