PVD

PERIPHERAL VASCULAR DISEASE

1. PERIPHERAL VASCULAR DISEASE BY:- SUDESHNA BANERJEE M.SC 1 ST YEAR MODERATOR: - MADAM GIJI JOHN LECTURER HFCON

2. 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

3. ETIOLOGY AND RISK FACTORS Primarily caused by atherosclerosis Embolism Thrombosis Trauma Vasospasm Inflammation Family history Sedentary lifestyle Stress Autoimmunity Smoking Hypertension obesity

4. 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

5. Clinical manifestation

6. TYPES Thromboangitis obliterans Raynauds disease Aneurysm Arterial embolism Deep vein thrombosis(DVT)

7. Thromboangitis obliterans Acute inflammatory lesions and occlusive thrombosis of the arteries and veins Strong association with smoking Commonly occurs in male between 20-40yrs

8. CLINICAL MANIFESTATIONS OF THROMBOANGITIS OBLITERANS Intermittent claudication Pain during rest Coldness Paresthesia Weak or absent pulse in posterior tibial , dorsalis pedis Extremities are cyanotic Ulceration and gangrene

9. INTERVENTIONS Advise patient to stop smoking Avoid trauma Emotional support Avoid injuries to feet Amputation of leg is done only when G angrene extends well into foot Pain is severe Severe infection

10. 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

11. ETIOLOGY Unknown etiology Common in women may be stimulated by stress, hypersensitivity to cold

12. CLINICAL MANIFESTATIONS OF RAYNAUDS DISEASE During arterial spasm-sluggish blood flow occurs Following the spasm the area becomes reddened with tingling & throbbing sensation With longstanding raynaud’s disease-ulcerations can develop on fingertips & toes

13. 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

14. 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

15. 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 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

16. 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

17. THORACIC AORTIC ANEURYSM A neurysm in the thoracic area C an develop in the ascending, transverse or descending aorta S/ Sx C hest pain C ough D yspnea H oarseness D ysphagia

18. ABDOMINAL AORTIC ANEURYSM Abdominal aorta below the renal arteries S/ Sx : P ulsatile abdominal mass on palpation P ain or tenderness in the mid-or upper abdomen T he aneurysm may extend to impinge on the renal, iliac, or mesenteric arteries S tasis of blood favors thrombus formation along the wall of the vessel

19. 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

20. Arterial Embolism Blood clots floating in the circulating arterial blood The embolus is frequently a fragment of arterioschlerotic plaque loosened from the aorta Emboli will tend to lodge in femoral or popliteal arteries, blood flow is impaired and ischemia develops

21. 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

22. 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

23. 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 thready & sensitive to pressure

24. 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 Fibrinolytic Vasodilator if needed to control vessel spasm

25. 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 Grading 0 - absent 1 + weak & thready 2 + normal 3 + full & bounding Prolonged(> 3 secs ) or absent capillary refill of nailbeds Loss of muscle tone or weakness

26. Diagnostic Evaluation Doppler ultrasonography Ankle brachial index to measure arterial blood flow Colour flow imaging Transcutaneous Oximetry Angiography

27. Complications Gangrene Extremity amputation Possible infection and sepsis

28. MEDICAL MANAGEMENT Weight reduction Exercise Stop smoking Blood lipid reduction Statins,Nicotinic acid, fibric acid derivative, bile acid resins Promote arterial flow- P entoxifylline Cilastazol – vasodilator & anti platelet Trendelenberg position

29. Surgical interventions Embolectomy Endartectomy is removal of a blood clot and stripping of atherosclerotic plaque along with the inner arterial wall Arterial by-pass surgery- an obstructed arterial segment may be by passed by using a prosthetic material( teflon ) or patient’s own artery or vein(saphenous vein) Percutaneous Transluminal Angioplasty - the balloon tip of the catheter is inflated to provide compression of the plaque Amputation

30. NURSING DIAGNOSIS Ineffective peripheral tissue perfusion Activity intolerance related to poor blood flow to the lower extremities Ineffective health maintainance related to smoking and lack of information about disease Risk for impaired skin integrity related to ischemic tissues of legs and feet

31. FOOT CARE FOR PATIENTS WITH PERIPHERAL ATHEROSCLEROSIS Keep legs & feet clean, dry & comfortable Clean with warm water & mild soap Pat dry using soft towel Apply cream after drying Wear a pair of cotton socks everyday 2. Prevent accidents and injuries to health Always wear shoes Walk on ground levels Don’t go barefoot Report if there is any foot problems

32. 3. Improve blood supply to legs & feet Don’t cross legs Don’t wear knee stockings Don’t swim in cold water

33. preventions Do passive exercise of legs Walk for atleast 30 mins daily Avoid cold water for bathing Stop smoking If edema occurs, then elevate the legs Dorsiflex legs at regular intervals to prevent venous pooling Avoid massaging the affected extremity Keep extremity warm but do not heat Use elastic stockings on affected leg

34. Health teaching Stop smoking Lose weight Eat low fat diet Avoid walking barefoot Begin walking & exercise programme Don’t wear restrictive clothing Wear proper fitting shoes