Peripheral Vascular Disease

PVD is a blood circulation disorder that causes the blood vessels outside of your
heart and brain to narrow, block or spasm. This can happen in your arteries and
veins. PVD often causes fatigue and pain, typically in your legs and specially
during exercise. Usually improves with rest.
Chronic Venous Insufficiency
(CVI)
Chronic Venous Insufficiency (CVI)

Venous Insufficiency results from obstruction of the venous valves in the legs of
a reflux of blood through the Valves. Both Superficial and deep leg veins can be
involved.

Venous System
- network of veins responsible for
carrying deoxygenated blood from
the organs back to the heart.
- Relies on the central pump of the
heart to circulate around your body.
Risk Factors

● More common in developing countries

● Age
● Pregnancy (progesterone)
● Congenital
● Genetic disposition
● prolonged standing
● Smoking
● Indirect or direct injury
● obesity
symptoms :

● Swelling in your legs and ankles

● Tight feeling in your calves or itchy or painful legs
● Pain when walking that can be relieved by rest
● Varicose veins
● Leg ulcers
● Leg cramps or muscle spasms
Treatment: Diagnosis:

● Improvement blood flow in your legs ● Vascular or Duplex UTZ

● Medicines ● Complete medical history
● Sclerotherapy ● Transducer
● Endovenous thermal ablation
● Lifestyle changes
● Quit smoking
Venous Thromboembolism
Deep Vein Thrombosis (DVT)

● A medical condition that occurs when a blood clot forms in a deep vein,
usually develops in the lower leg.
● It can happen to anybody and can cause serious illness, disability, and in
some cases even death.
Virchow’s Triad
Risk factors:

● Prolonged hospitalization or surgery

● Immobilized
● Age
● Obesity
● Pregnancy
● injury
Signs and symptoms:

● Pain
● Swelling
● Redness
● Warm to touch
● (+) homans sign
Diagnosis:

● UTZ
● Vernography
● D dimer blood test
Complication:

● Pulmonary Embolism
● Post phlebitic Syndrome
● bleeding
Treatment:

● Thrombolytic enzymes
● Thrombectomy
● Anticoagulant medication
● Compression stockings
● Calf exercises
Prevention

● Early ambulation
● Compression stockings
● Medication (anticoagulant)
● Wear loose-fitting clothing
● Weight management
Varicose Veins
Varicose Veins

● Distended, protruding veins that

appear darkened and tortuous are
evident.
● Swollen blood vessels
● Cluster of blue or purple veins
● Common on legs
Sign and symptoms:

● Swollen, twisted cluster of blue or purple veins

● Swollen legs, ankle or feet
● Muscle cramps, throbbing, soreness or aching
● Legs feel heavy
● Soreness behind the knww
● Itching around the vein
● Legs tire easily
Risk Factors:

● Gender : women
● Age
● Obesity
● Family history
● Lack of physical movement
Treatment :

● Sclerotheraphy
● Laser
○ Photoderm treatment
○ Laser treatment
○ Surgical ligation
○ Endovenous ablation
○ Endoscopic vein treatment
Cellulitis and Erysipelas
Cellulitis
● Bacterial skin infection of dermis and
subcutaneous tissue
● Group A hemolytic Streptococcus
● Streptococcus pneumoniae
Erysipelas
● “Superficial cellulitis”
● Streptococcus pyogenes
● Begins with minor trauma, such as a
bruise, burn, wound, or incision.
● Rash appears on the trunk, arms or legs it
is usually at the site of the surgical
incision or wound
Cellulitis Erysipelas

SIGN AND SYMPTOMS TREATMENT

● fever/ chills ● Antibiotics

● Butterfly appearance ● Elevate the affected area
● Warm ● Mark the area
● Tenderness
● Swelling
● Erythma
● red
Venous Ulcer & Arterial Ulcer
Venous Arterial

● Medial part of lower leg and ankle region ● End of toes

● Swollen ● Lateral ankle region
● Presence of granulation ● Little tissue granulation
● Irregular edges ● Shinny
● Shallow ● Decrease pulse
● Warm ● Painful
● Normal ABI
Calculating the ABI
An ABI is calculated for each leg. The ABI value is determined
by taking the higher pressure of the 2 arteries at the ankle,
divided by the brachial arterial systolic pressure. In calculating
the ABI, the higher of the two brachial systolic pressure
measurements is used. In normal individuals, there should be
a minimal (less than 10 mm Hg) interarm systolic pressure
gradient during a routine examination. A consistent difference
in pressure between the arms greater than 10mmHg is
suggestive of (and greater than 20mmHg is diagnostic of)
subclavian or axillary arterial stenosis, which may be
observed in individuals at risk for atherosclerosis.
Calculated ABI values should be recorded to 2 decimal
places.
Peripheral Arterial Disease
Peripheral Arterial Disease (PAD)

● common circulatory problem in which narrowed arteries reduce blood flow to your limbs.
● When you develop peripheral artery disease (PAD), your legs or arms — usually your legs — don't receive enough blood flow
to keep up with demand. This may cause symptoms, such as leg pain when walking (claudication)
● Peripheral artery disease is also likely to be a sign of a buildup of fatty deposits in your arteries (atherosclerosis). This
condition may narrow your arteries and reduce blood flow to your legs and, occasionally, your arms.
Risk factors

● Smoking
● DM
● Obesity
● High blood pressure
● High cholesterol
● Family history
Sign and symptoms:

● Absence of pulse
● Cool legs
● Round sore (ruber)
● Pale toes and feet
● Sharp pain upon exercise
● Intermittent claudication
● Intermittent calf pain
Complication

Critical limb ischemia. This condition begins as open sores that don't heal, an
injury, or an infection of your feet or legs. Critical limb ischemia occurs when the
injuries or infections progress and cause tissue death, sometimes requiring
amputation of the affected limb.

Stroke and heart attack. The atherosclerosis that causes the signs and
symptoms of peripheral artery disease isn't limited to your legs. Fat deposits also
build up in arteries supplying blood to your heart and brain.
Management

● Hang legs over bed

● Avoid contraptions ( crossing of legs)
● Percutaneous transluminal angioplasty
● Laser-assisted angioplasty
Raynauds disease & Buergers
Disease
Raynaud’s disease

● Vasospasm of the arterioles and arteries of the upper and lower extremities.
● Triggered by cold weather or stress
● Affects primarily the fingers, toes, ears and cheeks
● Vasoconstriction of arteries near skin
Sign and symptoms

● Cyanotic
● Cold
● Painful
● numb
Buerger’s Disease

● Thromboangiitis Obliterans
● Cold feet and hands worse when smoking
● Inflammatory condition impaired circulation to the extremities
Sign and symptoms

● Pain with movement

● Numbness and tingling
● Low temperature
● cyanosis
Aortic Aneurysm
Aortic Aneurysms

● An abnormal dilation of the arterial wall caused by localized weakness and

stretching in the medial layer or wall of an artery
● a bulge — like a bubble or a balloon — in a weakened area of the wall of the aorta or
across an entire segment of the aorta. Aortic aneurysm can lead to aortic rupture and
aortic dissection.
● AAA
● Asymptomatic
● Incidental finding
Risk Factor:

● Smoking
● Hypertension
● Hypercholesterolemia
● Gender
● Family history
Indication for surgery

● If the diameter has increased (5.5 cm)

● Rapid growth
● Symptomatic

Endovascular repair

Graft repair

AAA resection
Complication

● Renal failure
● Ischemia
● death
Aortic dissection
Aortic Dissection

● A tear in the inner aortic layer that allows blood to enter and further separate
the inner and middle layers of the wall of the aorta and typically extends
over a long length of the aorta in either direction and may extend into branch
vessels originating from the aorta.
Risk Factors:

● Hypertension
● Weakened aortic wall
● Aneurysm
● Connective tissue disorder
● trauma

COMPLICATION:

● Cardiac tamponade
● stroke
● Death
Sign and symptoms

● Sharp pain
● Weak pulse
● Different BP between left and right arms/ arteries
● Shortness of breath
● Stroke symptoms
● Confusion
● Muffled heart sound
Diagnostic exam

● CXR
● CT- ANgiography
● MR- Angiography
● Transthoracic Echocardiogram
● Transesophageal Echocardiogram
Treatment / Procedure

Surgery

● Graft replacement
● Endovascular graft stent repair
● Hybrid approach
● Beta blocker - type B