disorders of artery

1. PRESENTED BY
MISS ANAMIKA SHARMA
2ND YEAR M.Sc. NURSING

2. INTRODUCTION
• Blood vessel disorder generally refers to the
narrowing, hardening or enlargement of arteries
and veins.
• It is often due to the build-up of fatty deposits in
the lumen of blood vessels or infection of the
vessel wall.
• This can occur in various locations such as
coronary blood vessels, peripheral arteries and
veins.

3. ANATOMY AND PHYSIOLOGY OF
ARTERIES
• Arteries are thick-walled structures that carry blood
from the heart to the tissues. The aorta, which has
a diameter of approximately 25 mm (1 inch), gives
rise to numerous branches, which divide into
smaller arteries that are about 4 mm (0.16 inch) in
diameter by the time they reach the tissues. Within
the tissues the vessels divide further, diminishing to
approximately 30 µm in diameter; these vessels are
called arterioles.

4. • The walls of the arteries and arterioles are
composed of three layers:-
• The intima, an inner endothelial cell layer
• The media, a middle layer of smooth elastic tissue;
and
• The adventitia, an outer layer of connective tissue.

5. ARTERIOSCLEROSIS AND
ATHEROSCLEROSIS

6. • Arteriosclerosis refers to the loss of elasticity or
hardening of the arteries that accompanies the
aging process.
• As cells in arterial tissue layers degenerate with age,
calcium is deposited in the cytoplasm. The calcium
causes the arteries to lose elasticity.
• Atherosclerosis is a condition in which the lumen of
arteries fill with fatty deposits called plaque. The
plaque is chiefly composed of cholesterol, a fatty
(lipid) substance.
• Atherosclerosis lesions are of two types:
fatty streaks and
fibrous plaque.

7. CAUSES AND RISK FACTOR
Modifiable factors
 Nicotine use
• Diet (contributing to
hyperlipidemia)
• Hypertension
• Diabetes Mellitus Obesity
• Stress
• Sedentary lifestyle
• Elevated C- reactive protein
• Hyperhomocysteinemia
Non-modifiable risk factors
• Age
• Gender
• Familial
predisposition/genetics

8. CLINICAL MANIFESTATION
• The clinical signs and symptoms resulting from
atherosclerosis depend on the organ or tissue
affected.
• Coronary atherosclerosis (heart disease), angina
and acute myocardial infraction.
• Cerebrovascular disease including transient cerebral
ischemic attacks and stroke.
• Atherosclerosis of the aorta, including aneurysm,
atherosclerotic lesion of the extremities

9. MANAGEMENT
MEDICAL MANAGEMENT SURGICAL MANAGEMENT

10. • Arterial insufficiency of the extremities occurs most
often in men and is common cause of disability. The
legs are most frequently affected; however, the
upper extremities may be involved.
• In peripheral arterial disease obstructive lesions are
predominantly confined to segments of the arterial
system extending from the aorta below the renal
arteries to the popliteal artery.
• Distal occlusive disease is frequently seen in patient
with diabetes mellitus and in elderly patient.

11. CLINICAL MANIFESTATION
• The hallmark symptom of peripheral arterial
disease is intermittent claudication.
• As the disease progress, the patient may have a
decreased ability to walk the same distance as
previously or may notice increased pain with
ambulation.
• Ischemic rest pain is worst at night and often wakes
the patient.

12. MANAGEMENT
MEDICAL
MANAGEMENT
• Pentoxifylline (trental)
and cilostazol (pletal)
are approved for the
treatment of
symptomatic
claudication
• Antiplatelet agents
such as aspirin or
clopidogeral
• Statin therapy
SURGICAL
MANAGEMENT
• Bypass graft are
performed to reroute
the blood flow
• If the atherosclerotic
occlusion is below the
inguinal ligament in the
superficial femoral
artery, the surgical
procedure of choice is
the femoral to popliteal
graft.

13. UPPER EXTREMITY ARTERIAL OCCLUSIVE
DISEASE
• Arterial occlusion occur less frequently in upper
extremities (arms) than in the legs and cause less
severe symptoms because the collateral circulation is
significantly better in the arms. The arms also have
less muscle mass and are not subjected to the
workload of the legs.

14. CLINICAL
MANIFESTATION
• The patient typically
complains of arm
fatigue, and pain with
exercise (forearm
claudication)
• Inability to hold or grasp
objects
• The patient may
develop “subclavian
steal” syndrome
DIAGNOSTIC
EVALUATION
• coolness and pallor of
the affected extremity,
decreased capillary
refill, and difference in
arm blood pressures of
more than 20 mm Hg.
• Transcranial Doppler
evaluation is performed
to evaluate the
intracranial circulation

15. THROMBOANGITIS OBLITERANS
• Thromboangiitis obliterans, also known as Buerger
disease, is characterized by a recurring progressive
inflammation and thrombosis (clotting) of
intermediate small arteries and veins of the lower
and upper extremities. It results in thrombus
formation and segmental occlusion of the vessels.

16. CAUSES
• It is strongly associated
with use of tobacco
products, primarily from
smoking, but is also
associated with
smokeless tobacco.
• Exact cause is not
known.
CLINICAL
MANIFESTATION
• Pain
• Superficial
thrombophlebitis may
be present.
• Foot cramps
• Rubor (reddish-blue
discoloration) of the
foot and absence of the
pedal pulse but with
normal femoral and
popliteal pulses.

17. RAYNAUD’S PHENOMENON
• Raynaud’s disease also known as Raynaud’s
phenomenon
• Raynaud’s phenomenon is a form of intermittent
arteriolar vasoconstriction that results in coldness,
pain and pallor of the fingertips or toes.

18. TYPES OF RAYNAUD’S
PHENOMENON
• Primary or idiopathic Raynaud’s: It occurs in
the absence of an underlying disease it is the
most common and the milder of the two
types.
• Secondary Raynaud’s: it occurs in association
with an underlying disease, usually a
connective tissue disorder, such as systemic
lupus erythematous, rheumatoid arthritis, or
scleroderma, trauma or obstructive arterial
lesions

19. CAUSES
• Carpal tunnel syndrome
• Obstructive arterial
disease
• Some medications,
including beta-blockers,
certain Chemotherapy
drugs, and those that
cause vasoconstriction
• Thyroid disorders
CLINICAL
MANIFESTATION
• Pallor
• Cyanosis
• Hyperemia due to
vasodilation
• Numbness, tingling and
burning occurs as the
colour changes

20. ANEURYSM
An aneurysm is a localized sac or
dilation formed at a weak point
in the wall of the artery. It may
be classified by its shape or form.
Aneurysms of the aorta (aortic
arch, thoracic, abdominal) are
the most common, but
aneurysms can be found in other
arteries, such as those in the legs
and brain. The most common
form of aneurysm are saccular
and fusiform.

21. CLASSIFICATION OF ANEURYSM
• DEPENDING UPON COMPOSITION OF THE WALL
1] TRUE ANEURYSM 2] FALSE ANEURYSM
 DEPENDING UPON THE SHAPE
Saccular Having large spherical outpouching; ranging from 5-20 cms
in diameter
Fusiform Having slow spindle shape dilatation; 20 cms in diameter
Cylindrical Continuous parallel dilatation
Serpentine or
Varicose
Tortuous dilatation of the vessel
Racemose or
Cricoid
Having mass of intercommunicating small arteries and veins.

23. AORTIC ANEURYSM
• Abnormal dilatation of
the abdominal or
thoracic aorta

24. THORACIC AORTIC ANEURYSM
• Occurs above the diaphragm
• The thoracic area is the most common site for a
dissecting aneurysm. About one third of patients with
thoracic aneurysms die of rupture of the aneurysm

25. CLINICAL
MANIFESTATION
• Pain
• Dyspnoea
• Cough, frequently
paroxysmal and with a
brassy quality
• Hoarseness, stridor, or
weakness or aphonia
• Dysphagia
DIAGNOSTIC
EVALUATION
• Chest x-ray
• Transesophageal
echocardiography (TEE)
• Computed Tomography
Angiography (CTA).

26. ABDOMINAL AORTIC ANEURYSM
• Occurs in the abdominal portion of aorta
• The most common cause of abdominal aortic aneurysm
is atherosclerosis.
• If untreated, the eventual outcome may be rupture and
death.

27. MANAGEMENT
MEDICAL MANAGEMENT
• Antihypertensive
agents including
diuretics, beta blockers,
ACE inhibitors,
angiotensin II receptor
antagonist, and calcium
channel
SURGICAL MANAGEMENT
• Bypass graft
• Endovascular grafting

28. DISSECTING AORTA
• Occasionally, in an aorta diseased by arteriosclerosis,
a tear develops in the intima or the media
degenerates, resulting in dissection

29. CLINICAL MANIFESTATION
• Onset of symptom is usually sudden
• Severe and persistent pian, described as tearing or
ripping may be reported
• Sweating and tachycardia may be detected. Blood
pressure may be elevated or markedly different from
one arm to the other
• Cardiovascular, neurologic, and gastrointestinal
symptoms are responsible for other clinical
manifestations, depending on the location and
extent of the dissection.
• The patient may appear pale.

30. NURSING DIAGNOSIS
• Ineffective peripheral tissue perfusion related to
compromised circulation as evidenced by
cyanosis and loss of sensation
• Chronic pain related to impaired ability of
peripheral vessels to supply tissues with oxygen
as evidenced by pain scale rating
• Risk for impaired skin integrity related to
compromised circulation