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  2. INTRODUCTION • Blood vessel disorder generally refers to the narrowing, hardening or enlargement of arteries and veins. • It is often due to the build-up of fatty deposits in the lumen of blood vessels or infection of the vessel wall. • This can occur in various locations such as coronary blood vessels, peripheral arteries and veins.
  3. ANATOMY AND PHYSIOLOGY OF ARTERIES • Arteries are thick-walled structures that carry blood from the heart to the tissues. The aorta, which has a diameter of approximately 25 mm (1 inch), gives rise to numerous branches, which divide into smaller arteries that are about 4 mm (0.16 inch) in diameter by the time they reach the tissues. Within the tissues the vessels divide further, diminishing to approximately 30 µm in diameter; these vessels are called arterioles.
  4. • The walls of the arteries and arterioles are composed of three layers:- • The intima, an inner endothelial cell layer • The media, a middle layer of smooth elastic tissue; and • The adventitia, an outer layer of connective tissue.
  6. • Arteriosclerosis refers to the loss of elasticity or hardening of the arteries that accompanies the aging process. • As cells in arterial tissue layers degenerate with age, calcium is deposited in the cytoplasm. The calcium causes the arteries to lose elasticity. • Atherosclerosis is a condition in which the lumen of arteries fill with fatty deposits called plaque. The plaque is chiefly composed of cholesterol, a fatty (lipid) substance. • Atherosclerosis lesions are of two types: fatty streaks and fibrous plaque.
  7. CAUSES AND RISK FACTOR Modifiable factors  Nicotine use • Diet (contributing to hyperlipidemia) • Hypertension • Diabetes Mellitus Obesity • Stress • Sedentary lifestyle • Elevated C- reactive protein • Hyperhomocysteinemia Non-modifiable risk factors • Age • Gender • Familial predisposition/genetics
  8. CLINICAL MANIFESTATION • The clinical signs and symptoms resulting from atherosclerosis depend on the organ or tissue affected. • Coronary atherosclerosis (heart disease), angina and acute myocardial infraction. • Cerebrovascular disease including transient cerebral ischemic attacks and stroke. • Atherosclerosis of the aorta, including aneurysm, atherosclerotic lesion of the extremities
  10. • Arterial insufficiency of the extremities occurs most often in men and is common cause of disability. The legs are most frequently affected; however, the upper extremities may be involved. • In peripheral arterial disease obstructive lesions are predominantly confined to segments of the arterial system extending from the aorta below the renal arteries to the popliteal artery. • Distal occlusive disease is frequently seen in patient with diabetes mellitus and in elderly patient.
  11. CLINICAL MANIFESTATION • The hallmark symptom of peripheral arterial disease is intermittent claudication. • As the disease progress, the patient may have a decreased ability to walk the same distance as previously or may notice increased pain with ambulation. • Ischemic rest pain is worst at night and often wakes the patient.
  12. MANAGEMENT MEDICAL MANAGEMENT • Pentoxifylline (trental) and cilostazol (pletal) are approved for the treatment of symptomatic claudication • Antiplatelet agents such as aspirin or clopidogeral • Statin therapy SURGICAL MANAGEMENT • Bypass graft are performed to reroute the blood flow • If the atherosclerotic occlusion is below the inguinal ligament in the superficial femoral artery, the surgical procedure of choice is the femoral to popliteal graft.
  13. UPPER EXTREMITY ARTERIAL OCCLUSIVE DISEASE • Arterial occlusion occur less frequently in upper extremities (arms) than in the legs and cause less severe symptoms because the collateral circulation is significantly better in the arms. The arms also have less muscle mass and are not subjected to the workload of the legs.
  14. CLINICAL MANIFESTATION • The patient typically complains of arm fatigue, and pain with exercise (forearm claudication) • Inability to hold or grasp objects • The patient may develop “subclavian steal” syndrome DIAGNOSTIC EVALUATION • coolness and pallor of the affected extremity, decreased capillary refill, and difference in arm blood pressures of more than 20 mm Hg. • Transcranial Doppler evaluation is performed to evaluate the intracranial circulation
  15. THROMBOANGITIS OBLITERANS • Thromboangiitis obliterans, also known as Buerger disease, is characterized by a recurring progressive inflammation and thrombosis (clotting) of intermediate small arteries and veins of the lower and upper extremities. It results in thrombus formation and segmental occlusion of the vessels.
  16. CAUSES • It is strongly associated with use of tobacco products, primarily from smoking, but is also associated with smokeless tobacco. • Exact cause is not known. CLINICAL MANIFESTATION • Pain • Superficial thrombophlebitis may be present. • Foot cramps • Rubor (reddish-blue discoloration) of the foot and absence of the pedal pulse but with normal femoral and popliteal pulses.
  17. RAYNAUD’S PHENOMENON • Raynaud’s disease also known as Raynaud’s phenomenon • Raynaud’s phenomenon is a form of intermittent arteriolar vasoconstriction that results in coldness, pain and pallor of the fingertips or toes.
  18. TYPES OF RAYNAUD’S PHENOMENON • Primary or idiopathic Raynaud’s: It occurs in the absence of an underlying disease it is the most common and the milder of the two types. • Secondary Raynaud’s: it occurs in association with an underlying disease, usually a connective tissue disorder, such as systemic lupus erythematous, rheumatoid arthritis, or scleroderma, trauma or obstructive arterial lesions
  19. CAUSES • Carpal tunnel syndrome • Obstructive arterial disease • Some medications, including beta-blockers, certain Chemotherapy drugs, and those that cause vasoconstriction • Thyroid disorders CLINICAL MANIFESTATION • Pallor • Cyanosis • Hyperemia due to vasodilation • Numbness, tingling and burning occurs as the colour changes
  20. ANEURYSM An aneurysm is a localized sac or dilation formed at a weak point in the wall of the artery. It may be classified by its shape or form. Aneurysms of the aorta (aortic arch, thoracic, abdominal) are the most common, but aneurysms can be found in other arteries, such as those in the legs and brain. The most common form of aneurysm are saccular and fusiform.
  21. CLASSIFICATION OF ANEURYSM • DEPENDING UPON COMPOSITION OF THE WALL 1] TRUE ANEURYSM 2] FALSE ANEURYSM  DEPENDING UPON THE SHAPE Saccular Having large spherical outpouching; ranging from 5-20 cms in diameter Fusiform Having slow spindle shape dilatation; 20 cms in diameter Cylindrical Continuous parallel dilatation Serpentine or Varicose Tortuous dilatation of the vessel Racemose or Cricoid Having mass of intercommunicating small arteries and veins.
  22. AORTIC ANEURYSM • Abnormal dilatation of the abdominal or thoracic aorta
  23. THORACIC AORTIC ANEURYSM • Occurs above the diaphragm • The thoracic area is the most common site for a dissecting aneurysm. About one third of patients with thoracic aneurysms die of rupture of the aneurysm
  24. CLINICAL MANIFESTATION • Pain • Dyspnoea • Cough, frequently paroxysmal and with a brassy quality • Hoarseness, stridor, or weakness or aphonia • Dysphagia DIAGNOSTIC EVALUATION • Chest x-ray • Transesophageal echocardiography (TEE) • Computed Tomography Angiography (CTA).
  25. ABDOMINAL AORTIC ANEURYSM • Occurs in the abdominal portion of aorta • The most common cause of abdominal aortic aneurysm is atherosclerosis. • If untreated, the eventual outcome may be rupture and death.
  26. MANAGEMENT MEDICAL MANAGEMENT • Antihypertensive agents including diuretics, beta blockers, ACE inhibitors, angiotensin II receptor antagonist, and calcium channel SURGICAL MANAGEMENT • Bypass graft • Endovascular grafting
  27. DISSECTING AORTA • Occasionally, in an aorta diseased by arteriosclerosis, a tear develops in the intima or the media degenerates, resulting in dissection
  28. CLINICAL MANIFESTATION • Onset of symptom is usually sudden • Severe and persistent pian, described as tearing or ripping may be reported • Sweating and tachycardia may be detected. Blood pressure may be elevated or markedly different from one arm to the other • Cardiovascular, neurologic, and gastrointestinal symptoms are responsible for other clinical manifestations, depending on the location and extent of the dissection. • The patient may appear pale.
  29. NURSING DIAGNOSIS • Ineffective peripheral tissue perfusion related to compromised circulation as evidenced by cyanosis and loss of sensation • Chronic pain related to impaired ability of peripheral vessels to supply tissues with oxygen as evidenced by pain scale rating • Risk for impaired skin integrity related to compromised circulation