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Peripheral Vascular Disease Lecture Notes

Jul 7, 2024

Peripheral Vascular Disease (PVD)

Introduction

  • Peripheral Vascular Disease (PVD): Impediment of blood flow within the peripheral vascular system due to vessel damage.
  • Peripheral vascular system: Circulates blood to arms, hands, feet, and legs (outside the heart and brain).
  • Types: Can affect the arterial system (Peripheral Arterial Disease, PAD) or the venous system (Peripheral Venous Disease).
  • Symptoms: Primarily in lower extremities; symptoms differ for arterial vs. venous diseases.

Arterial vs. Venous System

Arterial System

  • Carries oxygenated blood from the heart to extremities and organs.
  • PAD: Result of atherosclerosis; fatty plaques limit blood flow, leading to pain, arterial ulcers, and possibly necrosis.

Venous System

  • Carries deoxygenated blood from extremities and organs back to the heart.
  • Peripheral Venous Diseases: Includes varicose veins and deep vein thrombosis (DVT) leading to venous congestion, pain, edema, and possible ulcers or cellulitis.

Risk Factors

Peripheral Arterial Disease (PAD)

  • Smoking: Causes arterial constriction.
  • Uncontrolled hypertension: Damages arteries.
  • High cholesterol: Leads to atherosclerosis.
  • Diabetes: Increases risk.

Peripheral Venous Disease

  • Female gender: Hormonal influences like birth control.
  • Pregnancy: Increases venous pressure.
  • Obesity: Leads to vein damage.
  • Prolonged sitting/standing: Damages vein valves.
  • Advanced age: Reduced vein function.

Types of Peripheral Arterial Disease

Peripheral Arterial Disease (PAD)

  • Cause: Atherosclerosis, smoking, hypertension, high cholesterol.
  • Symptoms: Ischemia, compromised tissue integrity.

Raynaud's Disease

  • Vasospasm: Affects toes, fingers, nose, ears; triggered by cold/stress.

Buerger's Disease

  • Inflammation: Affects arteries and veins, leading to clots; mainly in feet and hands.
  • Risk: Strongly associated with smoking.

Types of Peripheral Venous Disease

Varicose Veins

  • Symptoms: Rope-like veins on legs; managed with compression or procedures.

Deep Vein Thrombosis (DVT)

  • Symptoms: Extremity warmth, redness, pain.
  • Risk: Clot could lead to pulmonary embolism.

Superficial Venous Thrombosis

  • Location: Clots in superficial veins (hands, feet).

Chronic Venous Insufficiency

  • Symptoms: Overstretched veins; affects blood return to the heart.

Symptom Differences: Arterial vs. Venous Disease

Positions Alleviating Pain (V – Various positions)

  • Arterial Disease: Pain relieved by dangling legs (dependent position); worsened by elevation.
  • Venous Disease: Pain relieved by elevating legs; worsened by dangling/sitting/standing.

Explanation of Pain (E – Explanation)

  • Arterial Disease: Sharp, worse at night (rest pain); intermittent claudication (pain during activity).
  • Venous Disease: Heavy, dull, throbbing, achy; worse when standing or sitting; relieved by elevation.

Skin of Lower Extremity (S – Skin)

  • Arterial Disease: Cool, thin, dry, scaly skin; no hair; thick toenails; rubor when dangling, pale when elevated.
  • Venous Disease: Warm, thick, tough skin; brown pigmentation.

Strength of Pulse (S – Strength)

  • Arterial Disease: Poor or absent pulses.
  • Venous Disease: Present and normal pulses.

Edema Presence (E – Edema)

  • Arterial Disease: Typically not present.
  • Venous Disease: Common, worsens during the day.

Lesions (L – Lesions)

Arterial Ulcers

  • Location: Tips of toes, dorsum of feet, lateral ankle.
  • Characteristics: Little drainage, pale or necrotic base, deep, round edges.

Venous Ulcers

  • Location: Medial lower leg, medial ankle.
  • Characteristics: Swollen, lots of drainage, deep pink/red base, irregular edges, shallow.

Nursing Interventions for PAD

  • Circulation: Check pulses, color, sensation, temperature.
  • Patient Education: Avoid tight clothing, extreme cold; quit smoking; proper positioning.
  • Medications: Follow prescribed cholesterol-lowering drugs, anticoagulants.
  • Diet and Exercise: Low-fat diet, walking programs.
  • Skin Care: Inspect skin daily, avoid heating pads, test bath water temperature.
  • Pain Management: Regular assessment and management.

Diagnosing and Treating PAD

  • Ankle Brachial Index: Measures leg vs. arm pressure; ABI ratio <0.9 suggests PAD.
  • Procedures: Angioplasty, stenting, bypass surgery, arthrectomy.

Nursing Interventions for Peripheral Venous Disease

  • Blood Return: Elevate legs, apply compression stockings.
  • Clot Monitoring: Look for DVT symptoms, administer anticoagulants or use filters if necessary.
  • Wound Care: Clean compression stockings, manage venous stasis ulcers, use Unna boots.

Conclusion

  • Comprehensive understanding and intervention for PAD and venous diseases are crucial for effective patient management, focusing on improving circulation, managing pain, and promoting tissue integrity.

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