Peripheral Vascular Disease

PERIPHERAL VASCULAR
DISEASE
Peripheral vascular diseases
Major peripheral vascular disorders
Peripheral arterial disease

Peripheral vascular disease
Thromboangitis obliterans( Buerger’s Disease)
Raynaud phenomenon
ARTERIAL OCCLUSIVE DISEASE/PERIPHERAL VASCULAR
DISEASE
• The presence of systemic atherosclerosis distal to the arch
of the aorta which causes obstruction/narrowing of lumen
of the aorta and its major branches
• More common in men 60-70
• Risk factors –same as for atherosclerosis
• Most common risk factors are cigarette smoking and
diabetes
• Signs and symptoms depend on the site
• Primary symptom for femoral and popliteal artery is
intermittent claudication/ calf pain on walking(calf muscle
has the highest oxygen consumption of leg muscle group
while walking)
• Other symptoms include a vague aching feeling or
numbness rather than pain
PERIPHERAL VASCULAR DISEASE cont’d
• Cool extremities
• Weak/absent popliteal and pedal pulses
When blood flow is reduced to the extent it can no
longer meet the minimal needs of the resting muscle
Ischaemic pain at rest
Ulceration
Gangrene/tissue necrosis
Pain is now more severe, worsens at night when the
limb is elevated and lessens on standing
DIAGNOSTIC TESTS
• Inspection of limbs for ischaemia eg brittle toenails,
hair loss, pallor coolness
• Palpation of pedal pulses to detect obstruction
(femoral, popliteal, posterior tibial and dorsalis pedis)
• Doppler ultrasound
• MRI
• CT
• Angiography
TREATMENT
AIMS
 To protect affected tissues
 To preserve functional capacity
TREATMENT
 Depends on cause, location and size of obstruction
 Includes
 Cessation of smoking
 Control of hypertension and diabetes
 thromboendarterectomy
 Embolectomy
 Bypass graft
 Atherectomy
 Balloon angioplasty
 Thrombolytic therapy
 Antiplatelet therapy
DISORDERS OF THE VENOUS CIRCULATION
Varicose Veins
• Dilated tortuous veins that result from a sustained
increase in pressure that causes the venous valves to
become incompetent
• Can be described as primary or secondary
• Primary originate in the superficial saphenous veins
• Secondary result from impaired blood flow in the
deep channels
• Most common cause of secondary varicose veins is
deep vein thrombosis
DIAGNOSIS
• Physical inspection
• Special diagnostic tests
Trendelenburg’s test
Tourniquet test
Doppler ultrasound
Angiographic studies
TREATMENT
AIMS
1. To prevent the development and progression
2. To improve venous flow
3. To prevent tissue injury
MANAGEMENT
• CONSERVATIVE
Avoid activities that lead to elevated venous pressure eg prolonged
standing
Use of elastic support stockings
• SURGICAL
Stripping
Ligation
Sclerotherapy
Laser
CHRONIC VENOUS
INSUFFICIENCY
DEFINITION
• is a condition that occurs when the venous wall and/or valves in the
leg veins are not working effectively, making it difficult for blood to
return to the heart from the legs.
• CVI causes blood to “pool” or collect in these veins, and this pooling is
called stasis.
• CVI most commonly occurs as the result of a blood clot in the deep
veins of the legs, a disease known as deep vein thrombosis (DVT).
• CVI also results from pelvic tumors and vascular malformations, and
sometimes occurs for unknown reasons.
• Failure of the valves in leg veins to hold blood against gravity leads to
sluggish movement of blood out of the veins, resulting in swollen legs.
RISK FACTORS
• Deep vein thrombosis (DVT)
• Varicose veins or a family history of varicose veins
• Obesity
• Pregnancy
• Inactivity
• Smoking
• Extended periods of standing or sitting
• Female sex
• Age over 50
VENOUS THROMBOSIS
• Development of a thrombus in a superficial or deep vein
• Deep vein thrombus/DVT develops in the deep veins of pelvis or
extremities
• Leads to inflammation/thrombophlebitis
RISK FACTORS
Associated with
• Venous stasis- bed rest, prolonged immobility
• Increased blood coagulability- pregnancy, oral contraceptives
• Vessel wall injury-indwelling catheters, surgical trauma eg hip surgery
MANIFESTATIONS
• 50% are asymptomatic
• Fever
• General malaise
• Leg/calf pain
• Swelling of foot and ankle
• Deep muscle tenderness
DIAGNOSIS
• Venogram
• Duplex Ultrasound
• Laboratory tests- ESR and WBC
TREATMENT
• AIM- Prevention by
Early ambulation after childbirth and surgery
Leg exercises
Wearing of support stockings
Posture
Use of pneumatic compression device
TREATMENT
AIM(if not prevented)
 To prevent the formation of further thrombi
 To prevent extension and embolization of existing thrombi
 To minimize valve damage
Treatment measures include

 Elevate legs when sitting
 Avoid crossing legs when lying or sitting
 Heat application
 Bed rest
 Anticoagulation therapy
 Surgery

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PERIPHERAL VASCULAR

Peripheral arterial disease

Treatment measures include

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