PERIPHERAL VASCULAR DISEASES PHINMA-UPANG

Prof: Leonardo R. Sanchez IV, RN CHS Batch 2024

Adapted from: PowerPoint/Lecture NUR 155 (MS LEC)
Transcribed by: Julia Rae Delos Santos (3BSN-12) August 30, 2022

BUERGER’S DISEASE RAYNAUD’S DISEASE PATHOPHYSIOLOGY

- A recurring
inflammatory
infiltration (there is a
plaque formation on
the intimal wall that
causes partial or
Definition complete occlusion)
of intermediate and
small arteries and
veins of the lower
(feet) and rarely the
upper extremities
(hands).
- A form of
BUERGER’S DISEASE RAYNAUD’S DISEASE
intermittent or
Thrombus formation Cold stress
episodic arteriolar ↓ ↓
vasoconstriction, + inflammation Episodic arterial spasm
predominantly in + narrowed lumen ↓
hands. ↓ Intimal wall thickens because of
Artery is unable to transport adequate hypertrophy of medial wall resulting
blood volume to the tissue during from constant and repeated spasm or
exercise and rest constriction
↓ ↓
Total occlusion = Sluggish blood flow
Appearance of s/sx ↓
Total occlusion =
Appearance of s/sx

Synonyms THROMBOANGITIS VASOMOTOR MANIFESTATIONS

OBLITERANS ARTERIAL DISEASE
BUERGER’S DISEASE RAYNAUD’S DISEASE
Symptoms resulted from occlusion Symptoms resulted from arterial
of arteries, leading to ischemia, spasm, leading to ischemia
Unknown cause Unknown cause
complicated in later stages by
(Autoimmune) vasculitis but (Autoimmune) but usually infection (thrombolebitis) • Pain with cold stress;
Etiology usually associated with associated with emotional • Pain with exercise: most
smoking) stress and hypersensitivity usually at fingertips
common; usually bilaterally
to cold. symmetric at the arch of the
• Skin color and
foot; temperature changes
- it may occur during rest and • Ulcers and gangrene
Men Women sometimes persistent • Nail beds: capillary refill
Incidence 20-35 years old 20-40 years old • Intermittent claudication – is greater than 3 seconds
All races More on winter months most common symptom of
arterial insufficiency which
occurs during exercise.
 PERIPHERAL VASCULAR DISEASES PHINMA-UPANG
Prof: Leonardo R. Sanchez IV, RN CHS Batch 2024
Adapted from: PowerPoint/Lecture NUR 155 (MS LEC)
Transcribed by: Julia Rae Delos Santos (3BSN-12) August 30, 2022

• Skin color and temperature NURSING MANAGEMENT

changes
• Ulcers and gangrene
• Nail beds: capillary refill is
greater than 3 seconds
• Peripheral pulses; may be
diminished; audible bruit
DIAGNOSTICS
BUERGER’S DISEASE
• Physical examination
• Segmental limb pressure
• Doppler ultrasonography
• Arteriography or
angiography
• Transcutaneous
Oximetry
• MRI
BUERGER’S DISEASE RAYNAUD’S DISEASE
➢ Maintain a warm (Same as the Buerger’s Disease)
environment
➢ Legs in slight dependency ➢ Advise the patient to
and avoid elevating the wear gloves and warm
legs socks during winter
➢ Avoid vigorous massage months, in cleaning
of extremities refrigerator and in
➢ Advise patient to avoid handling frozen foods
RAYNAUD’S DISEASE constrictive clothing and ➢ Avoid occupations that
• Physical examination avoid crossing of legs require constant
• Cold stimulation test – ➢ Advise to quit smoking exposure to cold
fingers are placed in an ➢ Promote activity or
iced-water bath for 20 exercise; general
seconds. (+) for exercise; Buerger-Allen
Raynaud’s Phenomenon exercise
if the temperature of the ➢ Maintain skin integrity
fingers did not return to and prevent infection
normal after 20 minutes

SURGICAL MANAGEMENT
PHARMACOLOGICAL MANAGEMENT
BUERGER’S DISEASE RAYNAUD’S DISEASE
BUERGER’S DISEASE RAYNAUD’S DISEASE ❖ Arterial Bypass Surgery ❖ Sympathectomy
• Anticoagulants (heparin, • Calcium antagonist
warfarin) ❖ Percutaneous
• Vascular Smooth Muscle Transluminal Angioplasty
• Thrombolytics or Fibrolytics Relaxants
❖ Amputation ❖ Amputation
• Vasodilators • Vasodilators
 PERIPHERAL VASCULAR DISEASES PHINMA-UPANG
Prof: Leonardo R. Sanchez IV, RN CHS Batch 2024
Adapted from: PowerPoint/Lecture NUR 155 (MS LEC)
Transcribed by: Julia Rae Delos Santos (3BSN-12) August 30, 2022

ANEURYSM Etiologic Classification of Aneurysms

- Permanent bulging/stretching of an artery in which the dilation is two ▪ Congenital – primary connective tissue disorders (Marfan Syndrome,
times or greater the size of the artery Ehlers-Danlos Syndrome) and other diseases (focal medial agenesis,
- 3 sites commonly affected: tuberous sclerosis, Turner Syndrome, Menkes Syndrome)
a.) Aortic Arch b.) Thoracic Aorta c.) Abdominal Aorta ▪ Mechanical (hemodynamic) – poststenotic and arteriovenous and
amputation related
Thoracic Aortic Aneurysm
▪ Traumatic (pseudoaneurysm) – penetrating arterial injuries, blunt
Approximately 70% of all cases of thoracic aortic aneurysm are arterial injuries
caused by atherosclerosis. ▪ Inflammatory (non-infectious) – associated with arteritis (Takayasu
They occur most frequently in men between the ages of 50 to 70 disease, giant cell arteritis, SLE, Behcet syndrome, Kawasaki disease)
years, and are estimated to affect 10 of every 100,000 older adults. and periarterial inflammation (i.e. pancreatitis)
The thoracic area is the most common site for a dissecting aneurysm. ▪ Infectious (mycotic) – bacterial, fungal, spirochetal infection
▪ Pregnancy-related degenerative – non-specific, inflammatory
variant
Types of Aneurysm ▪ Anastomotic (postarteriotomy) and graft aneurysms – infection,
arterial wall failure, suture failure, and graft failure
False Aneurysm - actually a pulsating hematoma
Clinical Manifestations:
True Aneurysm – one, two or three arteries are involved.
• Some patients are asymptomatic
Fusiform aneurysm – • Pain is constant and occurs when person is in supine position
symmetric spindle-shaped • Dyspnea
expansion of entire • Paroxysmal cough
circumference of involved • Hoarseness, stridor, weakness or complete loss of voice (aphonia) –
vessel resulting from pressure in the laryngeal nerve
• Dysphagia
Saccular aneurysm – a
bulbous protrusion of one side Assessment and Diagnostic Findings:
of the arterial wall
➢ CXR
Dissecting aneurysm – this is ➢ CT Angiography
usually a hematoma that splits ➢ MRA (Magnetic Resonance Angiogram)
the layers of the arterial wall ➢ TEE (Transesophageal echocardiogram)
 PERIPHERAL VASCULAR DISEASES PHINMA-UPANG
Prof: Leonardo R. Sanchez IV, RN CHS Batch 2024
Adapted from: PowerPoint/Lecture NUR 155 (MS LEC)
Transcribed by: Julia Rae Delos Santos (3BSN-12) August 30, 2022

Medical/Surgical Management: Prevention and

Medical/Surgical Management:
➢ Controlling BP through anti-hypertensive drugs (e.g. beta-blockers,
ARBs, ACE inhibitors) ➢ Pt should avoid activities
➢ Repair of aneurysms using endovascular grafts (through CC) that cause venous stasis such as
wearing socks that are too tight
Nursing Management:
at the top, crossing the legs at
➢ Place patient in supine position after an endovascular repair. the thighs, and sitting or
➢ V/S and Doppler assessment of peripheral pulses are monitored standing for long periods
every 15 minutes ➢ Change position frequently
➢ Asses for bleeding, pulsation, swelling, pain, and hematoma elevating the legs 3-6 inches
formation at the access site higher than the heart
➢ Check for signs of embolization such as extremely tender, irregularly ➢ Pt is encouraged to walk 30
shaped, cyanotic areas, as well as changes in v/s, pulse quality, minutes each day
bleeding, swelling, pain, or hematoma ➢ Graduated compression stockings, especially knee-high stockings are
➢ Temperature is monitored every 4 hours, and check for signs of useful
postimplantation syndrome ➢ Ligation and Stripping
Postimplantation syndrome – typically begins within 24 hours of ➢ Thermal Ablation (Endovenous Laser Treatment)
stent graft placement and consists of spontaneously ➢ Sclerotherapy
Occurring fever, leukocytosis, and occasionally transient
Nursing Management
thrombocytopenia
➢ Check for signs of hemorrhage ➢ Advise patient that procedures are OPD
➢ Patient is advised to walk every hour for 5-10 minutes once the
sedation has worn off
Varicose Veins
➢ Advise the patient that graduated compression stockings are worn
- Dilation of veins because of lack of muscle support about 1 week after vein stripping
- Results from prolonged venous stasis ➢ Foot of the bed should be elevated
- common sites/related conditions: ➢ Standing and sitting are discouraged
❖ Saphenous vein
❖ Leg vein
❖ Hemorrhoids
❖ Esophageal varices