acs

1. Peripheral vascular diseases

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

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

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

9. 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

10. 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

11. 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

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

14. 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’sdisease-ulcerations
can develop on fingertips & toes

15. 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

16. 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

17. TYPES OF ANEURYSM
•Saccular aneurysm–involves only part of the
circumferenceof the artery
•Fusiform aneurysm –spindle shaped, involves the
entire circumferenceof 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

19. 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 & MRi

20. THORACIC AORTIC ANEURYSM
Aneurysm in the thoracic area
Can develop in the ascending, transverse or
descending aorta
S/Sx
•Chest pain
•Cough
•Dyspnea
•Hoarseness
•Dysphagia

21. ABDOMINAL AORTIC ANEURYSM
Abdominal aorta below the renal arteries
S/Sx:
•Pulsatile abdominal masson 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

23. 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

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

26. 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

27. 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

29. 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

31. 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

32. Assessment
• Condition of the skin: shiny, taut, absence of hair gro
• Ulcerations/ necrotic tissues
• Extremely cold to touch
• Peripheral pulses: diminished, weak, absent, bilatera
• Grading 0 -absent
1 + weak & thready
2 + normal
3 + full & bounding

33. • • Prolonged(> 3 secs) or absent capillary refill
of nailbeds
• • Loss of muscle tone or weakness

34. Diagnostic Evaluation
•Doppler ultrasonography
•Ankle brachial index to measure arterial blood flow
•Colourflow imaging
•Transcutaneous Oximetry
•Angiography

35. Complications
•Gangrene
•Extremity amputation
•Possible infection and sepsis

36. MEDICAL MANAGEMENT
•Weight reduction
•Exercise
•Stop smoking
•Blood lipid reduction
•Statins,Nicotinicacid, fibricacid derivative, bile acid
resins
•Promote arterial flow-Pentoxifylline
•Cilastazol –vasodilator & anti platelet
•Trendelenbergposition

37. Surgical interventions
• Embolectomy
• Endartectomyis 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 TransluminalAngioplasty-the balloon tip of
the catheter is inflated to provide compression of the
plaque
• Amputation

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

39. FOOT CARE FOR PATIENTS WITHPERIPHERALATHEROSCLEROSIS
1. Keep legs & feet clean, dry & comfortable
oClean with warm water & mild soap
oPat dry using soft towel
oApply cream after drying
oWear a pair of cotton socks everyday
2. Prevent accidents and injuries to health
oAlways wear shoes
oWalk on ground levels
o Don’t go barefoot
oReport if there is any foot problems

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

41. preventions
Do passive exercise of legs
Walk for atleast30 minsdaily
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