Vascular Disorders

Peripheral Arterial Disease of

the Lower Extremities
 Aortoiliac, femoral, popliteal, tibial, or peroneal arteries

 Classic symptom: Intermittent Claudication

 Ischemic muscle ache precipitated by a consistent level of
exercise
 Paresthesia – numbness / tingling in toes & feet
 Trophic changes: reactive hyperemia
dependent rubor
 Rest pain – nocturnal
Peripheral Arterial Disease
Peripheral Arterial Disease of
the Lower Extremities

 Diagnostics:

 Non-invasive: Doppler Studies

 Invasive: Angiography
 Peripheral Arterial Disease of
the Lower Extremities
 Treatment:

 Risk Factor Modification –

 HTN – Stepped Approach to Control
 Smoking - Cessation
 Treatment of hyperlipidemia - Nutrition
 Exercise – slow progressive walking

 Medication –
 Antiplatelet Therapy – Plavix / ASA
 < blood viscosity / >erythrocyte flexibility – Trental
 < platelet aggregation & promote vasodilation - Pletal
 Peripheral Arterial Disease of
the Lower Extremities
 Critical Limb Ischemia

 Interventional Radiology
 Percutaneous transluminal balloon angioplasty
 Atherectomy

 Surgical Revascularization
 Endarterectomy
 Graft angioplasty
 Peripheral artery bypass surgery

 End-stage surgery - amputation

 Vascular Disorders
Peripheral Arterial Disease of
the Lower Extremities
 Nursing Diagnoses

 Ineffective tissue perfusion

 Impaired skin integrity
 Acute pain
 Activity intolerance
 Ineffective therapeutic management
 Peripheral Arterial Disease of
the Lower Extremities
 Assess: Peripheral pulses, pallor, blanching,
hyperemia, warmth, capillary refill, ability to
bear weight and walk, pain, risk factors

 Nsg Action: Medication administration, prepare

for tests, treatment, surgery, prevent injury, skin
care, community referrals

 Pt/Family Education: Skin care, Medications,

risk factor modification, exercise
 Peripheral Vascular Disease
Thromboangiitis Obliterans
Buerger’s Disease
 Nonathersclerotic, segmental inflammation of
arteries, veins & nerves of upper and lower
extremities
 More common in men 25-40 years of age
 Correlates with cigarette smoking
 Rest pain, ischemic ulcerations
 Tx: smoking cessation / medications –
anti-platelets, vasodilators
 Surgical: Amputation
 Peripheral Disease
Clinical Manifestations
Peripheral Vascular Disease
Treatment
 Peripheral Vascular Disease
Raynaud’s Phenomenon
 Episodic vasospastic disorder of small cutaneous
arteries in fingers & toes
 Cause: Exaggerated SNS stimulation
 Occurs in women 15 -40 years of age
 May occur with collagen diseases: RA, scleroderma,
systemic lupus erythematosus
 Vasospasm Phase: Blanching of hands & fingers with
throbbing, aching pain, numbness, tingling
 Hyperemic Phase: swelling
 Tx: Smoking Cessation, no meds with vasoconstrictive

effect; avoid cold; avoid constrictive clothes;

Give Calcium-channel blockers