Peripheral Vascular Disease
-function: transportation, O2, proteins, nutrients
- 3 systems
I. Arterial System
II. Venous System
III. Lymphatic System
- the framework of the peripheral vascular system – BV
Layers of the BV
1. Tunica Intima
-AKA Tunica Interna
- Innermost Layer
- Layers: Basement Membrane
Connective Tissue
Endothelium (Only layer present in all BV)
2. Tunica Media
- Middle Layer of the BV
- Composed of a smooth mm.
- Bulk Tunica Media (Artery)
3. Tunica Adventitia
-Tunica externa
-outermost layer of the BV
- Composed of elastic, collagenous fiber
- Bulk (Veins)
I. Arterial System
- Artery
- Oxygenated Blood – away from the heart
- muscular, elastic and tubular extension of the heart
- Proximal
– inc. in pressure – therefore they are elastic
- Distal
- dec. in pressure – Muscular
- Artery – Arterioles – Capillaries (thin in nature)
“exchange vessel”
II. Venous System
- Veins
- Deoxygenated Blood
- towards the heart
- (+) valves
- carries 60 – 64% of Blood volume
- AKA Capacitance Vessel
3 Types of Vein
1. Superficial Veins
- Underneath the skin
- 2 great S.V. in the LE
- Great Saphenous V. – runs on the medial aspect of the leg
and thigh to join c the Femoral V.
- Lesser Saphenous Vein
- runs behind the Lat. Malleolus to the post. Leg to join the
popliteal V.
2. Perforating Vein AKA Communicating Vein
- connects the SV to the Deep Vein
3. Deep Vein
- Large veins that already follows the structure of an artery
III. Lymphatic System
- Lymphatics – carries fluid back to the blood steam
- (-) CNS, Corneas
- Lymph Nodes – Cervical, Axillary, Inguinal
- (+) Macrophages
PVD
I. Arterial Dse
1. Atherosclerosis Obliterans
- inflammation & occlusion affecting medium to large arteries
- MC: on LE>UE
- early warning signs: (+) int. claudication
- late stage: (+) Gangrene
- MC in non-DM patient: Abdominal Aorta, Common Iliac
Artery, Femoral A.
- MC in DM: Femoral Artery, Tibial Artery
- If Q in Board exam – Femoral A. Always
2. Thromboangitis Obliterans
- inflammation and occlusion affecting small A.
- MC UE>LE
- AKA Buerger’s Dse
- Dse. of a young male smoker
- Distal ➜ proximal / Ascending Pattern
3. Raynaud’s Phenomenon
- abnormal vasoconstriction reflex affecting small A.
- Precipitating Factors: Exposure to cold, Emotional Stress
- Cyclic Color Pattern –
Pallor, Cyanosis, Rubor (French Flag Sign)
II. Venous Diseases
4. Chronic Venous Insufficiency
- inc. pressure in the deep veins
- MC form of Venous Diseases
Stages
I: Edema & Pigmentation
II: Edema, Pigmentation, Varicosities & Dermatitis
III: Ulceration: MC manifestation of CVI
III. Lymphatic Diseases
1. Lymphadenopathy
- Enlargement of the lymph nodes c or without tenderness
- Dse of the Lymph nodes
1. Varicose Veins
- distended, swollen superficial veins
- MC affected: (+) Valves – inc. pressure in LE
- Prolonged Standing, Obesity, Pregnancy, Cross legs
- S/Sx: Aching, heavy leg, appearance of spider vein
2. Superficial Vein Thrombosis (Superficial Vein
Thrombophlebitis)
- inflammation and clot formation affecting SV
- MC affected: Saphenous Vein
- most serious complication: Varicosities
- S/Sx: Pain along the course of the saphenous Vein
3. Deep Vein Thrombosis
- Inflammation & clot formation affecting the deep vein
- Virchow’s Triad
H – Hypercoagulability
I - Intimal Wall damage
V - Venous Stasis
- (+) Homan’s Test
- Anti-coagulant
Heparin - IV
Warfarin – Oral
pt. should be immobilized
- MC complication of DVT is Pulmonary Embolus
- Best prevention: Early Mob.
2. Lymphedema
- Excessive accumulation of fluids in the tissue
Primary Lymphedema – Hereditary – genetic risk 25%
- Best initial exercise: Brisk walking
- Milroy’s Dse – edema after birth
- Lymphedema Praecox – edema present <35 yo
- Lymphedema Tarda – Edema >35 yo
Secondary Lymphedema
- surgery, malignancy, infection, tumor
Pulse
Temperature
Ulceration
AI
Dec. / Absent
Cold
L. Malleolus, Ant.
Tibia
Pain
Painful
Pale on Elevation
Dusky red on
dependency
(+) Gangrene
(+) Rest pain
VI
Normal
Normal
M. Malleolus,
Medial aspect of
leg & thigh
Painless
Pain (According to
Sulli) Relief of
pain from leg
elevation
(+) Edema
(+) Pigmentation
(+) Varicosities
(+) Dermatitis
Special Test
1. Claudication Time
- Arterial Insufficiency
- Treadmill
- measure the time or distance where the pain is felt
2. Stemmers Test
- Lymphedema
- Pinch Skin at the base of the 2nd toe
- Able Lift of skin = (-) Edema, (-) Stemmers
- Unable to lift = (+) Edema, (+) Stemmers
3. ABI – Ankle Brachial Index
- Arterial Insufficiency
- Doppler Ultrasound
- UE: Loc of Doppler – Brachial Pulse / Radial Answer Brachial
- Cuff Brachium
- LE: Loc. Doppler – Dorsalis Pedis / Post. Tib. Answer Dorsalis
- Cuff Calf Area
- LE / UE
- Interpretation
> 1.20 falsely elevation: DM
1.19 – 0.95 Normal
0.94 – 0.75 – mild art. Dse + int. Claudication
0.74 – 0.50 – mod art dse + rest pain
<0.50 Severe art. Dse