PERIPHERAL

VASCULAR
DISEASES
 BUERGER’S DISEASE RAYNAUD’S
DISEASE
- A recurring inflammatory - a form of
infiltration (there is a intermittent or
plaque formation on the episodic
intimal wall that causes arteriolar
partial or complete vasoconstriction,
Definition
occlusion) of intermediate predominantly in
and small arteries and hands
veins of the lower (feet)
and rarely the upper
extremities (hands).
THROMBOANGIITIS VASOMOTOR
Synonyms
OBLITERANS ARTERIAL DISEASE
 Unknown cause Unknown cause
(Autoimmune (autoimmune) but
Etiology vasculitis but usually usually associated with
associated with emotional stress and
smoking) hypersensitivity to cold.
Men Women
Incidence 20-35 years old 20-40 years old
All races More on winter months
 PATHOPHYSIOLOGY
Thrombus formation Cold stress
↓ ↓
+ Inflammation Episodic arterial spasm
= narrowed lumen ↓
↓ Intimal wall thickens
Artery is unable to because of hypertrophy of
transport adequate blood medial wall resulting from
volume to the tissue during constant and repeated
exercise and rest spasm or constriction
↓ ↓
Total occlusion = Sluggish blood flow
appearance of s/sx ↓
Total occlusion =
appearance of s/sx
 MANIFESTATIONS
Symptoms resulted from Symptoms resulted
occlusion of arteries, leading to from arterial spasm,
ischemia, complicated in later leading to ischemia
stages by infection
(thrombophlebitis)
• PAIN with exercise: most • PAIN with cold stress;
common; usually bilaterally usually at fingertips
symmetric at the arch of the
foot;
- It may occur during rest and
sometimes persistent
• Intermittent claudication –
most common symptom of
arterial insufficiency which
occurs during exercise
• Skin color and temperature • Skin color and
changes temperature changes

• Ulcers and gangrene • Ulcers and gangrene

• Nail beds: capillary refill is • Nail beds: capillary refill
greater than 3 seconds is greater than 3
• Peripheral pulses; may be seconds
diminished; audible bruit
 DIAGNOSTICS
• Physical Examination • Physical Examination

• Segmental limb pressure • Cold stimulation test –

fingers are placed in an
• Doppler ultrasonography iced-water bath for 20
seconds. (+) for Raynaud’s
• Arteriography or Phenomenon if the
angiography temperature of the
fingers did not return to
• Transcutaneous Oxymetry normal after 20 minutes

• MRI
 PHARMACOLOGICAL MANAGEMENT
• Anticoagulants • Calcium Antagonist

• Thrombolytics or • Vascular Smooth Muscle

Fibrolytics Relaxants

• Vasodilators
• Vasodilators
 NURSING MANAGEMENT
❖ Maintain a warm (Same as the Burguer’s
environment disease)

❖ Legs in slight dependency ❖ Advise the patient to

and avoid elevating the wear gloves and warm
legs socks during winter
months, in cleaning
❖ Avoid vigorous massage of refrigerator and in
extremities handling frozen foods.

❖ Advise patient to avoid ❖ Avoid occupations that

constrictive clothing and require constant
avoid crossing of legs exposure to cold.
 NURSING MANAGEMENT

❖ Advice to quit smoking

❖ Promote activity or
exercise; general exercise;
Buerger-Allen exercise

❖ Maintain skin integrity and

prevent infection
 SURGICAL MANAGEMENT
❖ Arterial Bypass Surgery ❖ Sympathectomy

❖ Percutaneous ❖ Amputation
Transluminal Angioplasty

❖ Amputation
Other Vascular Disorders:

ANEURYSM
- Permanent bulging/stretching of an artery in which
the dilation is two times or greater the size of the
artery
- 3 sites commonly affected: a) Aortic Arch, b)
Thoracic Aorta, c) Abdominal Aorta
 Thoracic Aortic Aneurysm
• Approximately 70% of all cases of thoracic
aortic aneurysm are caused by
atherosclerosis.
• They occur most frequently in men between
the ages of 50 to 70 years, and are estimated
to affect 10 of every 100,000 older adults.
• The thoracic area is the most common site for
a dissecting aneurysm.
False aneurysm – actually a pulsating
hematoma
True aneurysm – one, two, or three
Arteries are involved.
 Fusiform aneurysm – symmetric spindle-shaped
expansion of entire circumference of involved vessel
 Saccular aneurysm – a bulbous
protrusion of one side of the arterial
wall
Dissecting aneurysm – this is usually
a hematoma that splits the layers of
the arterial wall
-
 Etiologic Classification of Aneurysms
• Congenital – primary connective tissue
disorders (Marfan Syndrome, Ehlers-Danlos
Syndrome) and other diseases (focal medial
agenesis, tuberous sclerosis, Turner syndrome,
Menkes syndrome).
• Mechanical (hemodynamic) – poststenotic
and arteriovenous fistula and amputation
related
 Continuation
• Traumatic (pseudoaneurysm) – penetrating
arterial injuries, blunt arterial injuries,
• Inflammatory (non-infectious) – associated
with arteritis (Takayasu disease, giant cell
arteritis, SLE, Behcet syndrome, Kawasaki
disease) and periarterial inflammation (i.e.
pancreatitis)
• Infectious (mycotic) – bacterial, fungal,
spirochetal infection
 Continuation
• Pregnancy-related degenerative – non-
specific, inflammatory variant
• Anastomotic (postarteriotomy) and graft
aneurysms – infection, arterial wall failure,
suture failure, and graft failure
 Clinical Manifestations
• Some patients are asymptomatic.
• Pain is constant and occurs when person is in
supine position.
• Dyspnea
• Paroxysmal cough
• Hoarseness, stridor, weakness or complete loss of
voice (aphonia) – resulting from a pressure in the
laryngeal nerve
• Dysphagia
 Assessment and Diagnostic Findings
• CXR
• CT Angiography
• MRA (Magnetic Resonance Angiogram)
• TEE (Transesophageal echocardiography)
 Medical/Surgical Management
• Controlling BP through anti-hypertensive
drugs (e.g. Beta-blockers, ARBs, ACE
inhibitors)
• Repair of aneurysms using endovascular grafts
(through CC)
 Nursing Management
• Place patient in supine position after an
endovascular repair.
• V/S and Doppler assessment of peripheral pulses
are monitored every 15 minutes.
• Assess for bleeding, pulsation, swelling, pain and
hematoma formation at the access site.
• Check for signs of embolization such as extremely
tender, irregularly shaped, cyanotic areas, as well
as changes in v/s, pulse quality, bleeding,
swelling, pain, or hematoma.
 Continuation
• Temperature is monitored every 4 hours, and
check for signs of postimplantation syndrome.
• Postimplantation syndrome – typically begins
within 24 hours of stent graft placement and
consists of spontaneously occurring fever,
leukocytosis, and occasionally transient
thrombocytopenia.
• Check for signs of hemorrhage
VARICOSE VEINS
Dilation of veins because of lack of muscle
support – results from prolonged venous
stasis
Common sites/related conditions:
❖ Saphenous vein
❖ Leg vein
❖ Hemorrhoids
❖ Esophageal varices
 Prevention and Medical/Surgical
Management
• Pt should avoid activities that cause venous
stasis such as wearing socks that are too tight
at the top, crossing the legs at the thighs, and
sitting or standing for long periods.
• Change position frequently elevating the legs
3-6 inches higher than the heart.
• Pt is encouraged to walk 30 minutes each day.
• Graduated compression stockings, especially
knee-high stockings are useful.
Ligation and stripping
Thermal Ablation
Sclerotherapy
 Nursing Management
• Advise patient that procedures are OPD.
• Patient is advised to walk every hour for 5-10
minutes once the sedation has worn off.
• Advise the patient that graduated
compression stockings are worn about 1 week
after vein stripping.
• Foot of the bed should be elevated.
• Standing and sitting are discouraged.