Peripheral Vascular system

—Dilate or constrict depending on metabolic needs of tissues

—Oxygenation and waste product removal

—Direct the flow of the blood in one continuous direction

—Heart failure

—thrombus, embolus

—atherosclerotic plaque,

—chemical or mechanical injury

—inflammatory processes

—vaso-spastic disorders

—congenital malformations

—obstruction/pressure

plaque build up of the artery , no peripheral pulse that’s a clue of PVD and edema use a doppler

—Physical assessment of peripheral pulses

—Lab values

—Doppler ultrasound flow studies

—Duplex ultrasound (imaging of tissues, organs, and vessels)

—Exercise tolerance testing (treadmill)

Diagnostic test for PVD

—Evaluate arterial flow in lower extremties


—Uses a doppler and ultrasound to evaluate flow

—May need to wear blood pressure cuffs on your arms and legs for this test.

Compares blood pressure in arms to legs – measuring the ABI (ankle – brachial index

cross-sectional views of tissues usually with contrast medium

3-D view of aorta and visceral arteries

isolates blood vessels (no contrast medium)

hardening of the arteries or full-thickness hardening of small arteries and arterioles

occurs with the aging process, hardening of the arteries

involves accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on intimal layer of large and medium-sized arteries

the plaque formation

poor perfusion and oxygenation

narrowing of the lumen, obstruction by thrombosis, plaque ulceration, aneurysm, rupture

• diet, HTN, DM, Hyperlipidemia, Stress, smoking,
• sedentary lifestyle, age, family history

—Hypertension

—Angina

—Myocardial infarction

—Transient ischemic attacks (TIA) and stroke

—Aneurysm

—Renal vascular disease/end-stage renal disease

—Skin changes r/t color and temperature: “dependent rubor”, or “ elevation pallor”

—Diminished or absent pulse

• Ulcers (usually on toes or near toes, +pain, neurologic deficits present
• —Dependent on stage or severity of arterial insufficiency

—Pain at Rest

Pain or intermittent claudication

Angioplasty and stent placement

—Percutaneous Transluminal Angioplasty (PTA)

—Laser- Assisted Angioplasty

—Atherectomy

—Peripheral arterial bypass operation with autogenous vein to carry blood around the lesion or occlusion.

- important to assess for occlusion (pulses, temp etc.)

- report of pain (type of pain)

-bedrest for 18-24 hours

- check blood pressure

- notify surgeon immediately for abnormal findings

opening the carotid artery and removing the obstructing plaque.

—Monitor vital signs, neuro status, pulses, bleeding,

—Hematoma


—Embolus

—Dissection

—Bleeding

—Stent embolization or dislodgement

—Vessel damage

—Positioning affected part below heart level

—If edema, position slightly elevated but not above the heart

—Walking or graded isometric exercises to promote circulation and development of collateral circulation

• —medications (vasodilators, lipid lowering agents,
• anti-platelet agents)

—No smoking!

—surgery

—applications of warmth,

—avoidance of cold temperatures,

avoid heating pads and hot-water bottles

—avoid emotional upsets,

—removal of restrictive clothing or accessories

—avoid crossing the legs, inspection of legs and feet

—nutrition: weight reduction

—Diet low fat, low sodium,

—Encourage soy proteins, folic acid and B6 and B12 vitamins

• Folic acid on arterial disorders: homosistene when high causes more plaque formation so when you give
• folic acid it decreases it

Soy lowers your cholesterol level

—Legs most effected, men 50 + years

—Below renal arteries to popliteal artery

—Aching, cramping, fatigue, weakness relieved with rest; with severity, pain worse at night/at rest

—Effects the arms/upper extremities

—Unilateral coolness, discrepancy of 20 mm HG or more on BP right to left

—Autoimmune vasculitis resulting in in microscopic occlusion of distal vessels caused by heavy smoking/chewing tobacco

smoking directly related causes vessel to inflame and have narrowing of the vessels


When pt stops smoking inflammation does subside

—extreme sensitivity to cold aggravated by nicotine, emotion, chilling, limited to hands and feet

—Phenomenon (usually unilaterally)

—Treatment and education related to preventing vasoconstriction

Can be stress, cold, nicotine , usually one hand or two fingers and promote vasodilation


Reduce stress, wear gloves

localized sac or dilation (thoracic, abdominal, dissecting aneurysm)

occlusion/clot

—Results of prolonged venous hypertension that stretches the vein and damages the valves

—Damage and hypertension leads to back-up of blood resulting in edema

—Difficulty eliminating waste and thus they build-up in the tissues resulting in stasis, ulcers, edema, cellulitis


Usually around ankles

—Venous thrombosis

—Deep vein thrombosis

—Thrombophlebitis


Virchow’s triad:

VENOUS STASIS, DAMAGE TO INTIMAL LINING, INCREASED BLOOD VISCOSITY

elderly, bed ridden, post-op patients, oral contraceptives, HRT, smokers, pregnant females, obese, people who stand for a prolonged period of time

—Pain, warmth, redness, and edema

—Prominence of superficial veins

—Positive Homan’s sign

—Signs of pulmonary embolus

—Ulcers (usually ankle area, +pulses, no claudication, no neurologic deficits)

—Elastic stockings, pneumonic compression device, positioning, exercise

Heparin IV or SQ

Coumadin oral

Low-molecular weight heparin (Lovenox), less risk of thrombocytopenia

—Thrombolytics

—ASA, Ecotrin, Bayer, Plavix

• PTT (partial thromboplastin time), 2-3x average
• INR (international normalized ratio)2.0-3.0

platelet count

• PT (prothrombin time) 1.5-2x average
• INR 2.0-3.0

—Bleeding

—Drug interactions: (ASA, anabolic steroids,, glucagon, chloramphenicol, neomycin, etc) POTENTIATE oral anticoagulant effects

• —Drug interactions: (Dilantin, barbituates, diuretics,
• estrogens), DECREASE anticoagulant effects

—leg elevation,

—elastic stockings

—removal of restrictive garments

—proper nutrition

—Collaborate with Wound care specialist

—Intermittent pneumatic compression pump

—Varicose veins and venous reflux: VNUS procedure