Med-Surg Week 5: Vascular Disorders

Vascular Disorders

• Can lead to impaired perfusion, resulting in ischemia, which is a reversible cellular injury caused by a lack of blood flow and oxygen.
• Ischemia can progress to infarction or necrosis, which is the death of tissue with an inability to regenerate.

Causes of Arterial Insufficiency

• Arteriosclerosis: the walls of arteries become hardened, which occurs with aging.
• Atherosclerosis: the accumulation of lipids, blood components, and other cells on the innermost layer of the arterial wall.
• Emboli: a clot in an artery.

Causes of Venous Insufficiency

• Dysfunction of valves, which can be caused by prolonged standing or smoking.
• Prevention and treatment: compression stockings and vein treatments.

Risk Factors for Vascular Disorders

• Smoking
• High cholesterol
• Sedentary lifestyle
• Obesity
• Diabetes
• Hypertension
• Age
• Sex

Smoking as a Risk Factor

• Acts as a vasoconstrictor
• Impairs oxygen transport
• Impairs cellular oxygen use
• Increases blood viscosity
• Increases homocysteine levels

Arterial Disorders

• Peripheral Artery Disease (PAD)
• Abdominal Aortic Aneurysms (AAI)
• Aneurysms

Peripheral Artery Disease (PAD)

• Narrowing of the arteries in the upper and lower extremities
• Related to other cardiovascular diseases
• Higher risk of premature death from cardiovascular disease, coronary events, and stroke
• Causes: atherosclerosis, lipid accumulation, connective tissue deposits, muscle cell replication, and immune cell infiltration

Common Sites of PAD

• Iliac
• Femoral
• Popliteal
• Tibial
• Carotid (not shown)
• Coronary (not shown)

Risk Factors for PAD

• Smoking
• Hyperlipidemia
• C-reactive protein
• Uncontrolled hypertension
• Sedentary lifestyle
• Obesity
• Diabetes mellitus

Clinical Manifestations of PAD

• Often no symptoms until 60-75% of the vessel is occluded
• Symptoms depend on the site of PAD
• Classic manifestation: intermittent claudication, which is an ischemic muscle ache or pain that is precipitated by constant exercise and relieved with 10 minutes of rest

Examples of PAD Symptoms

• Iliac PAD: claudication in buttocks and thighs
• Femoral or popliteal PAD: claudication in calves

Diagnostics for PAD

• Doppler ultrasound to map blood flow
• Segmental blood pressures while the patient is supine
• Ankle-brachial pressure index (ABI) to determine the ratio of BP in the upper extremity vs. the lower (ankle/brachial)

Goals of Therapy for PAD

• Protect from further trauma and provide good foot care
• Decrease ischemic pain
• Provide proper wound care and prevent/control infection
• PAD/CVD prevention measures
• Consider revascularization therapies, such as bypass grafting or removal of obstructive plaque, with amputation as a last resort