PERIPHERAL
VASCULAR DISEASES
DR. Mohamed Seyam PhD. PT.
Assistant Professor Of Physical Therapy
For Cardiovascular /Respiratory Disorder
Types of Arteries
Elastic arteries – the largest arteries
2. Muscular – the distributing arteries
3. Arterioles – the Smallest arteries
1.
Structure of Blood Vessels
Tunica
intima
Tunica media
Tunica externa
1- Aneurysm
An aneurysm is a localized, blood-filled balloon-like bulge in
the wall of a blood vessel .
• It
may produce no symptoms (small than 5 cm),
• It
may cause problems through pressing on adjacent structures.
• may
become occluded with thrombus or rupture.
Aneurysms can be classified by their
location:
- 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).
 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.
Causes of aneurysm
1- Atherosclerosis
2- Trauma such as, penetrating , acute blunt and constricted trauma.
3- Infections such as syphilis , Tuberculosis.
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
 In
primary varicose veins, the incompetence tends to
progress downward in the saphenous main channel.
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 :
• Radiofrequency treatment. (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.
surgical
management
• Phlebectomy
is a treatment for superficial varicose veins.
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