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Peripheral Vascular Disorder: Atherosclerosis - Coggle Diagram
Peripheral Vascular Disorder: Atherosclerosis
Atherosclerosis
Form of arteriosclerosis in which deposits of fat and fibrin obstruct and harden the arteries
Peripheral Vascular Disease (PVD)
Disease caused by the pathologic changes that impair blood supply to the peripheral tissues particular the lower extremities in the peripheral circulation
Pathophysiology
Involves both intima & media of the artery
Type 2 (~ 25%)
Aorta, common & external iliac arteries
Type 3 (~ 60-70%)
Aorta, iliac, femoral, popliteal & tibial arteries
Type 1 (~ 10-15%)
Aorta & iliac arteries
Signs & Symptom
Paralysis
Pulseless
Pallor
Paraesthesia
Pain
Clinical Manifestation
Diminished or absent peripheral pulses
Pallor with extremity elevation
Dependent rubor (dark red) when dependent i.e. hanging over side of bed
Paraesthesia
Numbness, decreased sensations
Thin, shiny, hairless skin
Thicken toenails
Rest pain
Occurs during period of inactivity, burning sensation; if leg elevated
Discoloration or skin breakdown
Oedema if severe
Intermittent claudication
Cramping or aching pain at the calves, thigh and buttocks
S/s of complication
Gangrene, extremity amputation, rupture of AAA, infection and sepsis
Risk Factors
Modifiable
Obesity
Stress
Sedentary lifestyle
Diabetes Mellitus
Diet contributing to hyperlipidaemia
Hypertension
Nicotine use
Non-Modifiable
Gender
Family h/o vascular disorders, MI, stroke
Age
Diagnostic Investigation
Segmental pressure measurement
Use sphygmomanometer cuffs and a Doppler devise to compare BP between upper and lower extremities and different segments of affected extremities – BP legs < arms
Stress test
Using treadmill to assess functional assessment limitations - pressure ankle ↓ with exercise
History and physical examination
Doppler U/Sound
Use sound waves reflected off (sound/ wave) moving RBC within a vessel to evaluate blood flow - waveform progressively flatter
Transcutaneous oximetry
Evaluate oxygenation of tissues
Duplex Doppler US
Combines audible / graphic Doppler US with US imaging to identify arterial or venous abnormalities
Angiography / Magnetic Resonance angiography
To locate and evaluate extent of arterial obstruction; In angiography, contrast medium injected and fluoroscopy and x-ray used to visualise vessels ; MRI no contrast required
Medical Management
Pentoxifylline (Trental)
To ↓ blood viscosity, ↑ RBC flexibility, ↑ blood flow to microcirculation and tissues of the extremities
Platelet inhibitor i.e. Cilostazol (Pletal)
To improve cloudification
Vasodilators prostaglandins
To ↓ pain and ↑ healing in patients with severe limb ischemia
Thrombolytics i.e. streptokinase (Steptase)
To dissolve clots and relieve obstruction caused by thrombus
Anti platelet i.e. aspirin, clopidogrel (Plavix)
To ↓ risk of arterial thrombosis
Medical Management
Regular progressively strenuous exercise
~ 30- 45 mins of walking daily is important
Advised patient to rest
At the onset of claudication, resume activity when pain resolves
Elevate the head of bed
On blocks to help relieve rest pain
Recommend measures
To slow atherosclerosis i.e. control diabetes, hypertension, lower cholesterol levels and weight loss
Avoid using restrictive clothing
I.e elastic support hose as it causes ↓ circulation
Meticulous foot care
Vital to prevent ulceration and infection
Smoking cessation
Vital as it causes vasospasm
Surgical Management
Percutaneous transluminal balloon angioplasty (PTCA)
To dilate narrowed lumen by compressing obstruction using balloon inflation
Thromboendarterectomy
Open artery to remove thrombus and medial layer of arterial wall post angiography; used with autogenous vein / Dacron bypass surgery
Atherectomy
To excise plaque using drill or slicing mechanism
Embolectomy
A balloon tip catheter used to remove thrombotic material
Stent placement
Mesh wire inserted o maintain vessel patency
Nursing Interventions
Nursing Intervention (Preoperative)
Nursing Intervention (Postoperative)
Complications
Gangrene leading to limb amputation
Impaired nail and hair growth
Skin ulceration
Stroke or TIA
Severe ischemia and necrosis
Peripheral or systemic embolism
Nursing Diagnoses