Disorders of the

Peripheral Vascular System

Peripheral Arterial Occlusive Disease
Atherosclerosis obliterans, arterial
insufficiency, and peripheral vascular
disease
Common sites for arterial occlusion are
the distal superficial femoral and the
popliteal arteries
Occlusions prevent delivery of oxygen and
nutrients to the tissues
Hypoxia affects all tissues distal to the
occlusion

Peripheral Arterial Occlusive Disease
Signs and symptoms
Intermittent claudication
Absence of peripheral pulses below
occlusive area
Rest pain
Tingling or numbness or both in the toes
Extremity is cold, numb, and pale
Shiny, scaly skin; subcutaneous tissue
loss; hairlessness on the affected
extremity; and ulcers with a pale gray or
yellowish hue, especially at ankles

Peripheral Arterial Occlusive Disease
Medical diagnosis
Duplex imaging
Angiography

Peripheral Arterial Occlusive Disease
Medical and surgical treatment
Lifestyle changes
Smoking cessation, exercise, weight
management
Treatment for hypertension,
hyperlipidemia, or diabetes
Drugs for claudication: cilostazol and
pentoxifylline
Surgical interventions
Percutaneous transluminal angioplasty,
atherectomy, and endarterectomy

Aneurysms
Pathophysiology
A dilated segment of an artery caused
by weakness and stretching of the
arterial wall; can be congenital or
acquired

Aneurysms
Signs and symptoms
Thoracic aneurysms usually have no
symptoms, though some report deep,
diffuse chest pain
If aneurysm puts pressure on the
recurrent laryngeal nerve, patient may
complain of hoarseness
Pressure on the esophagus may cause
dysphagia
Aneurysms
Signs and symptoms
If superior vena cava compressed,
edema of the head and arms
Signs of airway obstruction may be
present if the aneurysm presses against
pulmonary structures
Abdominal aneurysms may be palpated
as a pulsating mass in the area slightly
left of the umbilicus

Aneurysms
Complications
Rupture, thrombus formation that
obstructs blood flow, emboli, pressure
on surrounding structures
Medical diagnosis
Physical findings, echocardiography,
ultrasonography, computed tomography,
aortography
Aneurysms

Medical and surgical treatment
Repair of aneurysms done by replacing
the dilated segment of the artery with
synthetic graft or, in some cases, by
suturing or patching the defective area

Venous Thrombosis
Pathophysiology
Phlebitis
Inflammation of the vein wall
Thrombophlebitis
Clot has formed at the site of inflammation
within a vein
Phlebothrombosis
Presence of a thrombus in a vein as a result
of stasis, deviation of the intima, or
hypercoagulability
Deep vein thrombosis
Clot in a deep vein rather than in superficial
vessels

Venous Thrombosis
Risk factors
Prescribed bed rest
Surgery for people older than 40 years
of age
Leg trauma resulting in immobilization
from casts or traction
Previous venous insufciency
Obesity
Use of oral contraceptives

Venous Thrombosis
Signs and symptoms
Deep vein
Edema, warmth, and tenderness at the area
of compromise; positive Homans sign
Superficial vessels
Pain, redness, warmth, or tenderness in the
affected area

Venous Thrombosis
Medical diagnosis
Venography, Doppler ultrasonography,
and duplex ultrasonography
Lung scan, pulmonary angiogram, or
spiral CT scan if pulmonary embolism is
suspected

Venous Thrombosis
Medical and surgical treatment
Anticoagulant or thrombolytic therapy, or
both
Patient teaching about the disease;
ongoing assessment for pulmonary
emboli; bed rest; elevation of the
extremity; warm, moist soaks to the
affected area; and antiembolism hose
Surgery considered when patient cannot
receive anticoagulants or thrombolytic
therapy or when high possibility of
pulmonary emboli