PERIPHERAL
VASCULAR DISEASES
DR. Mohamed Seyam PhD. PT.
Assistant Professor Of Physical Therapy
For Cardiovascular /Respiratory Disorder
Structure of Blood Vessels
• Composed
of three layers (tunics)
Tunica
intima – composed of simple squamous epithelium
Tunica
media – sheets of smooth muscle
Contraction – vasoconstriction
Relaxation – vasodilatation
Tunica
externa – composed of connective tissue
-Lumen
Types of Arteries
Elastic arteries – the largest arteries
••
Diameters range from 2.5 cm to 1 cm
••
Includes the aorta and its major branches
••
Sometimes called conducting arteries
••
High elastin content
Muscular (distributing) arteries
•
Lie distal to elastic arteries
•
Diameters range from 1 cm to 0.3 mm
•
Includes most named arteries
•
Tunica media is thick
•
Unique features
•
Internal and external elastic lamina
Arterioles
•
Smallest arteries
•
Diameters range from 0.3 mm to 10 µm
•
Larger arterioles possess all three tunics
Capillaries
• Diameter
• Red
from 8–10 µm
blood cells pass through single file
• Site-specific
functions of capillaries
• Lungs
– oxygen enters blood, carbon dioxide leaves
• Small
intestines – receive digested nutrients
• Endocrine
• Kidneys
glands – pick up hormones
– removal of nitrogenous wastes
Veins
• Conduct
• Blood
blood from capillaries toward the heart
pressure is much lower than in arteries
• Smallest
veins – called venules
• Diameters
• Smallest
• Venules
• Tunica
from 8 – 100 µm
venules – called postcapillary venules
join to form veins
externa is the thickest tunic in veins
Vascular Anastomoses
• Vessels
interconnect to form vascular anastomoses
• Organs
receive blood from more than one arterial source
• Neighboring
• Provide
• Veins
arteries form arterial anastomoses
collateral channels
anastomose more frequently than arteries
Vasa Vasorum
• Vasa
vasorum vessels of vessels
• Nourish
outer region of large vessels
1- Aneurysm
An aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall
of a blood vessel or
An aneurysm is a localized dilatation of the weaken medial layer wall of a large and
medium sized arteries, such as the aorta and cerebral arteries.
•
It may produce no symptoms (small than 5 cm),
•
may cause problems through pressing on adjacent structures or
•
may become occluded with thrombus or rupture, with potential devastating effects.
As an aneurysm increases in size, the risk of rupture increases. A ruptured
aneurysm can lead to bleeding and subsequent hypovolemic shock, leading to
death.
•
Aneurysms are a result of a weakened blood vessel wall, and can be a result of a
hereditary condition or an acquired disease.
Aneurysms can be classified by their
location:
- Arterial and venous .
- The heart .
- The aorta, including:
- Thoracic aortic aneurysms
- Abdominal aortic aneurysms.
-The brain, cerebral aneurysms
-The legs, the popliteal arteries.
- The kidney, renal artery aneurysm.
- Capillaries, capillary aneurysms.
Classifications
• True And False Aneurysms
 A true aneurysm is one that involves all three layers of the wall of
an artery (intima, media and adventitia).
True aneurysms include atherosclerotic, syphilitic, and congenital
aneurysms, as well as ventricular aneurysms.
 A false aneurysm, or pseudo-aneurysm, is a collection of blood
leaking completely out of an artery or vein, but confined next to the
vessel by the surrounding tissue.
This blood-filled cavity will eventually either thrombose (clot)
enough to seal the leak, or rupture out of the surrounding tissue.
Causes of aneurysm
1- Atherosclerosis
2- Trauma such as, penetrating , acute blunt (Having a dull edge or not
having a sharp edge ) ,
constricted trauma (. To make smaller or
narrower by squeezing
3- Infections such as syphilis , Tuberculosis, causing Rasmussen's
aneurysms and brain infections, causing infectious intracranial aneurysms
4- Arteritis such as polyarteritis nodosa (PAN)
• Polyarteritis nodosa is an autoimmune disease that affects arteries.
5- Congenital defects.
6- Copper deficiency affecting elastin, results in vessel wall thinning.
Physical therapy treatment
•
Take all medications as recommended by your physician.
•
The goals of your program should be to increase your endurance level, joint
range of motion and ability to perform activities of daily living.
•
Choose activities that are comfortable and well-tolerated, such as walking,
swimming, or low-intensity sports such as bowling.
•
Start slowly and emphasize duration over intensity.
•
Gradually progress to exercising 15 to 20 minutes,
•
Three or more days per week.
•
All exercise training, whether aerobic or resistance, should be performed at
moderate to-low intensity
2- Varicose Veins
• Varicose
veins are enlarged any veins, but the veins most commonly
affected are those in legs and feet.
• That's
because standing upright increases the pressure in the veins
of lower body.
• Varicose
veins are dilated, elongated, and tortuous superficial veins
of the lower extremities that look blue in the lower limb
• They
are produced by incompetent valves and increased
intraluminal pressure.
Hemosiderosis
Dilated veins
Stasis pigmentation
and dermatitis
Superficial varicose
vein
Etiology
1- Primary varicose veins.
• Primary
varicose veins result from hereditary weakness of the
vein wall and valves.
2- Secondary varicose veins.
• It
is a sequel to deep venous thrombosis resulting from
a) Dilation of collateral veins.
b) Damage to valves of deep veins.
Pathophysiology
1- Increase venous pressure in the upright posture
2- The vein increases both in length and diameter so that tortuousities develop
and varicosity extends progressively throughout the length of the affected vein.
3- Dilatation of the affected veins, causes separation of the valve cusps (valve
incompetent)..
4- Valves incompetent of deep veins, leads to chronic venous stasis
5- loss of elastic tissue, muscle atrophy of the media layer and hypertrophy of the
outer layer
6- In primary varicose veins, the incompetence tends to progress downward in the
saphenous main channel and in its tributaries.
7- In secondary varicose veins, which arise because of deep vein insufficiency, the
incompetence tends to progress upward from incompetent perforating veins in
the lower one third of the leg.
Symptoms
1- Symptoms vary in degree.
No symptoms in less sever cases (superficial varicose veins), and often
concerned about the cosmetic appearance of the legs.
2- Aching in the legs, aggravated by standing, and improved by
walking and elevation elevation of lower limb.
3- Fatigue, pain in the legs with difficulty in walking.
4- The legs feel heavy and occasionally mild ankle edema develops
5- Superficial venous thrombosis may be a recurring problem and
rarely varicosity ruptures and bleeds.
Complications
1- Bleeding following rupture of vein.
2- Venous ulcer due to devitalized skin.
3- Superficial venous thrombosis.
4- Edema, particularly of the foot and ankle.
5- Pigmentation: black to brown due to hemosiderin from RBCs breakdown,
6- Dermatitis is an inflammation of the skin.
7-Cellulitis is a diffuse inflammation of connective tissue, caused by bacteria,
with severe inflammation of dermal and subcutaneous layers of the skin.
Management
1.
2.
3.
4.
Assessment
Conservative.
Surgical
Physical therapy.
2- Conservative
a)
Avoid : - prolonged standing, sitting, obesity, constricting
garments.
b)
Avoid Shower or bathe in the evening.
c)
Apply well—fitted below the knee support stockings (20 - 40
mm Hg) before ambulating in the morning or exercising.
d)
Above the knee heavy support stockings generally are not
necessary, since the majority of symptoms from varicose veins
occur below the knee where venous pressure is highest.
e)
Elevate the feet 10-15 minutes, 3-4 times daily
f)
Avoid trauma to varicose veins .
3- Surgical and Nonsurgical
•
Nonsurgical management
•
Sclerotherapy :
•
This is not recommended, it Is the injection of ta sclerosing agent (chemical irritant) into
the varicose vein which makes them shrink
•
Radiofrequency treatment. Radiofrequency energy (instead of laser energy) is used
inside a vein to scar and close it off. It can be used to close off a large varicose vein in the
leg.
Doctors are using new technology in laser
treatments to close off smaller varicose veins and
spider veins. Laser surgery works by sending
strong bursts of light onto the vein, which makes
the vein slowly fade and disappear. No incisions or
needles are used
.
•
phlebectomy is a treatment for superficial varicose veins.
•
The procedure involves the removal of the varicose veins through small 2–3 mm
incisions in the skin overlying the veins.
•
The procedure may be performed in hospital or outpatient settings.
•
The procedure may be performed with tumescent local anesthesia, such as with
lidocaine.
•
Complications are uncommon, but include paresthesia, bruising, and hematoma.
•
Graded compression stockings are usually worn for 1–2 weeks after the procedure.
•
Patients usually return to normal light activity immediately after the procedure.
•
This procedure is often used as an adjunct to endovenous laser treatment or other
endovenous ablations of the greater saphenous vein
4- Physical therapy management
• Aims
1- Assist venous return
2- Avoid venous stasis and its complications
• Methods
1.
Positioning
2.
Bandaging
3.
Pneumatic compression therapy
4.
Electromagnetic therapy
5.
exercise