Vascular Disorders

Overview of Vascular Health

  • Focus on cardiovascular and vascular system.

  • Definition of vascular: anything below the heart including legs, aorta, and veins.

Peripheral Arterial Disease (PAD)

  • Also known as Peripheral Vascular Disease (PVD).

  • Definition: Blockages in peripheral arteries.

    • Primarily affects the legs.

  • Key characteristics:

    • Progressive narrowing of artery walls in upper and lower extremities.

    • Similar to blockages in the heart.

  • Risk population: 50 to 70 years of age; symptoms may appear earlier in diabetics.

Risk Factors for PAD

  • Consistent with those for coronary artery disease:

    • Smoking

    • Diabetes

    • Hypertension

    • High cholesterol

  • Implications: Blockages in heart increase risk of similar issues in legs.

Atherosclerosis

  • Definition: Plaque buildup in arteries.

  • Consequences: Increased risk of coronary artery disease or cerebral artery disease.

    • High potential for strokes.

  • Common sites for plaque buildup span from the aorta to the calves.

Symptoms of PAD

  • Intermittent claudication: pain in legs that occurs with walking and stops with rest.

    • Rationale: Muscle oxygen demand during walking not met due to blockage.

  • Ischemic: Lack of blood supply to muscle.

  • Key clinical signs:

    • Loss of hair on legs.

    • Cool skin temperature.

    • Weak or absent pulses in popliteal, pedal, and femoral arteries.

  • Foot presentation:

    • Pale upon elevation; hyperemia (redness) when dependent.

    • Potential for tingling or loss of sensation, increasing injury risk.

  • Advanced stages:

    • Pain may occur at rest, particularly at night.

  • Complications from PAD can lead to gangrene and amputation due to insufficient blood flow.

Treatment Strategies for PAD

  • Primary interventions include:

    • Smoking cessation: A critical factor to prevent amputation.

    • Diabetes management: Lower A1C levels.

    • Cholesterol management: Target bad cholesterol < 100 mg/dL.

    • Maintain low blood pressure.

  • Diagnostic tools:

    • Doppler ultrasound to assess blood flow.

    • Ankle-bracial index (ABI): compares leg and arm blood pressure to identify blockages.

    • Angiography: injects dye to visualize blockages.

  • Treatment alignment with coronary artery disease:

    • ACE inhibitors (monitor potassium levels).

    • Antiplatelet agents (such as aspirin or clopidogrel).

    • Dietary modifications and exercise to improve circulation.

Surgical Treatments for PAD

  • Bypass grafts using synthetic grafts (similar to heart treatment).

  • Goal: Adequate tissue perfusion & preventing complications.

Assessment Criteria

  • Evaluate:

    • Skin color and temperature.

    • Capillary refill and pulse strength.

  • Post-surgery monitoring includes:

    • Avoiding knee flexion to maintain blood supply.

    • Noticing signs of ischemia, such as pain and color changes.

Aortic Disorders

Aortic Aneurysms

  • Definition: Outpouching or dilation of arterial wall.

  • Common locations: abdominal or thoracic aorta.

Risk Factors for Aortic Aneurysms

  • Similar to PAD and CAD:

    • Hypertension

    • High cholesterol

    • Family history

    • Smoking

Detection and Symptoms

  • Often asymptomatic until rupture occurs; may be found incidentally.

  • Symptoms may include back pain or pulsatile mass.

  • Rupture can lead to massive hemorrhage, associated with high mortality rate.

Treatment Strategies for Aortic Aneurysms

  • Regular monitoring through ultrasound or CT scans if aneurysm is small (< 5.4 cm).

  • Surgical intervention recommended if size exceeds 5.5 cm or shows rapid growth.

Aortic Dissection

  • Definition: Tear in the inner layer of artery wall, different from an aneurysm (which is bulging).

Clinical Manifestations

  • Symptoms include sudden and severe chest pain, potentially mimicking a heart attack.

  • Additional signs: low blood pressure, distended neck veins, muffled heart sounds.

Diagnosis and Management

  • Diagnostic tools include chest X-ray, EKG, MRI, transesophageal echocardiogram.

  • Immediate management includes controlling blood pressure and heart rate, often utilizing beta blockers.

Venous Thrombosis

Definition and Causes

  • Venous stasis: pooling of blood leading to clot formation.

  • Damage to vessel walls or hypercoagulable states can contribute to thombosis.

Signs and Symptoms

  • Unilateral leg edema: Swelling in one leg, pain, warmth, and erythema.

Prevention Strategies

  • Early mobilization after surgery.

  • Use of TED hose and sequential compression devices (SCDs).

  • Anticoagulants like warfarin for high-risk patients.

Anticoagulation Management

  • Warfarin: Takes 48-72 hours for therapeutic effect.

  • INR monitoring: Target 2-3 for effective anticoagulation.

  • Antidote for Warfarin: Vitamin K; Heparin needs monitoring with APTT.

  • Reversal agent for Heparin: Protamine sulfate.

Thrombolytic Therapy

  • Use during acute clot formation: TPA and urokinase can dissolve clots but carry increased risk of bleeding.

Chronic Venous Insufficiency

Overview

  • Insufficient venous return leading to swelling, ulcers, and discoloration of legs.

  • Caused by failure of vein valves and blood pooling.

Management Strategies

  • Compression therapy (TED hose).

  • Maintain leg elevation and mobilization to reduce symptoms.