Peripheral Vascular Disease

• Peripheral Vascular Diseases (PVDs): Conditions impairing blood supply to peripheral tissues, notably lower extremities.

• Types of PVD:

  • Peripheral Arterial Disease (PAD)

  • Chronic Venous Insufficiency (CVI)

Risk Factors

• Smoking

• Hypertension

• High cholesterol

• Diabetes mellitus

• Family history of vascular disease

• Overweight and physical inactivity

• Male

• Older adults (over age 80)

• Black (compared to hispanic or white)

Prevention

• Maintaining a healthy lifestyle

• Following treatment regimens for chronic illnesses

• Screening of at risk patients

• Using claudication medications alongside lifestyle changes such as:

  • Prescribed antihypertensive medications

  • Cholesterol-lowering medications

  • Drugs to prevent blood clots

Diagnostics

• Segmental pressure measurements: Ankle-Brachial Index (ABI)

• Stress testing and Doppler ultrasound

• Transcutaneous oximetry

• Angiography or MRI

Management Goals

• Slow disease progression

• Support maintenance of tissue perfusion

• Provide symptom relief

• Prevent complications and promote circulation healing

Pharmacologic Therapy

• Inhibit platelet aggregation (e.g. Aspirin, Clopidogrel)

• Cilostazol: Increases blood flow to extremities

• Pentoxifylline: Decreases blood viscosity, increases RBC flexibility

Non-Pharmacologic Management

• Lifestyle modifications:

  • Smoking cessation, regular exercise programs

  • Weight control, dietary management

  • Foot care education for high-risk individuals

Surgical Interventions

Surgical Options

• Revascularization recommended for severe or progressive symptoms including:

  • Endarterectomy

  • Bypass grafts

  • Percutaneous transluminal angioplasty and stent placement

Risks

• Increased potential for operative complications with surgical options but improved graft patency rates.

Complementary Health Approaches

• Aromatherapy

• Biofeedback

• Healing touch/massage

• Yoga and antioxidant-rich diets

Nursing Process

Assessment Elements

• Observation of pain, edema, skin changes.

• Interview to gather current medication, social history, and lifestyle changes relevant to PVD.

Nursing Diagnosis

Possible Nursing Diagnoses for PVD

• Ineffective Peripheral Tissue Perfusion

• Chronic Pain

• Impaired Skin Integrity

• Activity Intolerance

Possible Nursing Diagnoses for CVI

• Disturbed Body Image

• Ineffective Health Maintenance

• Risk for Infection

Planning and Implementation

Goals for Patient

• Smoking cessation

• Foot care education

• Compliance with treatment plans

Implementation Strategies

• Promote circulation through positioning and regular assessment of extremities

• Manage pain and promote skin integrity

Evaluation of Outcomes

• Assessment of patient’s understanding and demonstration of care techniques, adherence to informed treatment plans, and encouragement for positive lifestyle changes.

Peripheral Arterial Disease

• Characterized by arterial occlusion leading to insufficient blood flow.

• Typically manifests in the lower limbs.

Pathophysiology

• Atherosclerotic Lesions:

  • Involve the intima and media layers of arteries.

• Thromboses:

  • Occur more frequently in lower extremities than upper.

• Arteriosclerosis:

  • Particularly in the abdominal aorta, can lead to aneurysms.

• Plaque Formation:

  • Typically occurs at arterial bifurcations.

Manifestations

• Pain characteristics

  • Intermittent claudication

  • Rest pain

• Physical examination findings:

  • Peripheral pulses decreased or absent, bruit over affected arteries

  • Skin changes: thin, shiny, hairless with discolored areas

  • Thickened toenails

  • Skin breakdown and ulceration areas

  • Dependent rubar, pallor

• Symptoms improve rapidly upon rest, typically in minutes.

Arterial Ulcers

• Pain: Intermittent claudication, sharp

• Edema: Absent

• Pulse: Weak or absent

• Drainage: None

• Characteristics: Round, smooth, black eschar, and typically located at toes and feet.

Peripheral Venous Disease/Chronic Venous Insufficiency (PVD/CVI)

• Condition of inadequate venous return over a prolonged period.

• Often results from deep vein thrombosis (DVT).

Pathophysiology

• Results from venous stasis in the lower leg, leading to:

  • Venous stasis ulcers

  • Inadequate supply of oxygen, nutrients impeding metabolic energy

  • Prevents effective inflammatory and immune responses

  • Increased risk for infection in ulcerated tissue

Risk Factors

• Smoking

• Hypertension

• High cholesterol

Manifestations

• Lower extremity edema

• Cyanotic extremity appearance

• Recurrent stasis ulcers

Venous Ulcers

• Pain: Dull, achy, typically lower leg

• Edema: Present

• Pulse: Present

• Drainage: Substantial, slough with irregular borders

• Characteristics: Sores with irregular borders, typically on ankles