The document discusses peripheral arterial disease (PAD) affecting the lower extremities, including its symptoms such as intermittent claudication and rest pain, as well as diagnostic methods like Doppler studies and angiography. It outlines treatment options including risk factor modification, medication, interventional procedures, and surgical options for critical limb ischemia. Additionally, it covers related vascular disorders, including thromboangiitis obliterans and Raynaud's phenomenon, detailing their causes, manifestations, and treatment strategies.

1. Vascular Disorders
Vascular Disorders
Peripheral Arterial Disease of
Peripheral Arterial Disease of
the Lower Extremities
the Lower Extremities
 Aortoiliac, femoral, popliteal, tibial, or peroneal arteries
Aortoiliac, femoral, popliteal, tibial, or peroneal arteries
 Classic symptom: Intermittent Claudication
Classic symptom: Intermittent Claudication
 Ischemic muscle ache precipitated by a consistent level
Ischemic muscle ache precipitated by a consistent level
of exercise
of exercise
 Paresthesia – numbness / tingling in toes & feet
Paresthesia – numbness / tingling in toes & feet
 Trophic changes: reactive hyperemia
Trophic changes: reactive hyperemia
dependent rubor
dependent rubor
 Rest pain – nocturnal
Rest pain – nocturnal

2. Peripheral Arterial Disease
Peripheral Arterial Disease

3. Peripheral Arterial Disease of
Peripheral Arterial Disease of
the Lower Extremities
the Lower Extremities
 Diagnostics:
Diagnostics:
 Non-invasive: Doppler Studies
Non-invasive: Doppler Studies
 Invasive: Angiography
Invasive: Angiography

4. Peripheral Arterial Disease of
Peripheral Arterial Disease of
the Lower Extremities
the Lower Extremities
 Treatment:
Treatment:
 Risk Factor Modification –
Risk Factor Modification –
 HTN – Stepped Approach to Control
HTN – Stepped Approach to Control
 Smoking - Cessation
Smoking - Cessation
 Treatment of hyperlipidemia - Nutrition
Treatment of hyperlipidemia - Nutrition
 Exercise – slow progressive walking
Exercise – slow progressive walking
 Medication –
Medication –
 Antiplatelet Therapy – Plavix / ASA
Antiplatelet Therapy – Plavix / ASA
 < blood viscosity / >erythrocyte flexibility – Trental
< blood viscosity / >erythrocyte flexibility – Trental
 < platelet aggregation & promote vasodilation - Pletal
< platelet aggregation & promote vasodilation - Pletal

5. P
Peripheral Arterial Disease of
eripheral Arterial Disease of
the Lower Extremities
the Lower Extremities
 Critical Limb Ischemia
Critical Limb Ischemia
 Interventional Radiology
Interventional Radiology
 Percutaneous transluminal balloon angioplasty
Percutaneous transluminal balloon angioplasty
 Atherectomy
Atherectomy
 Surgical Revascularization
Surgical Revascularization
 Endarterectomy
Endarterectomy
 Graft angioplasty
Graft angioplasty
 Peripheral artery bypass surgery
Peripheral artery bypass surgery
 End-stage surgery - amputation
End-stage surgery - amputation

6. Vascular Disorders
Vascular Disorders
Peripheral Arterial Disease of
Peripheral Arterial Disease of
the Lower Extremities
the Lower Extremities
 Nursing Diagnoses
Nursing Diagnoses
 Ineffective tissue perfusion
Ineffective tissue perfusion
 Impaired skin integrity
Impaired skin integrity
 Acute pain
Acute pain
 Activity intolerance
Activity intolerance
 Ineffective therapeutic management
Ineffective therapeutic management

7. Peripheral Arterial Disease of
Peripheral Arterial Disease of
the Lower Extremities
the Lower Extremities
 Assess
Assess: Peripheral pulses, pallor, blanching,
: Peripheral pulses, pallor, blanching,
hyperemia, warmth, capillary refill, ability to
hyperemia, warmth, capillary refill, ability to
bear weight and walk, pain, risk factors
bear weight and walk, pain, risk factors
 Nsg Action
Nsg Action: Medication administration,
: Medication administration,
prepare for tests, treatment, surgery, prevent
prepare for tests, treatment, surgery, prevent
injury, skin care, community referrals
injury, skin care, community referrals
 Pt/Family Education
Pt/Family Education: Skin care, Medications,
: Skin care, Medications,
risk factor modification, exercise
risk factor modification, exercise

8. Peripheral Vascular Disease
Peripheral Vascular Disease
Thromboangiitis Obliterans
Thromboangiitis Obliterans
Buerger’s Disease
Buerger’s Disease
 Nonathersclerotic, segmental
Nonathersclerotic, segmental
inflammation of arteries, veins & nerves of
inflammation of arteries, veins & nerves of
upper and lower extremities
upper and lower extremities
 More common in men 25-40 years of age
More common in men 25-40 years of age
 Correlates with cigarette smoking
Correlates with cigarette smoking
 Rest pain, ischemic ulcerations
Rest pain, ischemic ulcerations
 Tx: smoking cessation / medications –
Tx: smoking cessation / medications –
anti-platelets, vasodilators
anti-platelets, vasodilators
 Surgical: Amputation
Surgical: Amputation

9. Peripheral Disease
Peripheral Disease
Clinical Manifestations
Clinical Manifestations

10. Peripheral Vascular Disease
Peripheral Vascular Disease
Treatment
Treatment

11. Peripheral Vascular Disease
Peripheral Vascular Disease
Raynaud’s Phenomenon
Raynaud’s Phenomenon
 Episodic vasospastic disorder of small cutaneous
Episodic vasospastic disorder of small cutaneous
arteries in fingers & toes
arteries in fingers & toes
 Cause: Exaggerated SNS stimulation
Cause: Exaggerated SNS stimulation
 Occurs in women 15 -40 years of age
Occurs in women 15 -40 years of age
 May occur with collagen diseases: RA, scleroderma,
May occur with collagen diseases: RA, scleroderma,
systemic lupus erythematosus
systemic lupus erythematosus
 Vasospasm Phase: Blanching of hands & fingers with
Vasospasm Phase: Blanching of hands & fingers with
throbbing, aching pain, numbness, tingling
throbbing, aching pain, numbness, tingling
 Hyperemic Phase: swelling
Hyperemic Phase: swelling
 Tx: Smoking Cessation, no meds with vasoconstrictive
Tx: Smoking Cessation, no meds with vasoconstrictive
effect; avoid cold; avoid constrictive clothes;
effect; avoid cold; avoid constrictive clothes;
Give Calcium-channel blockers
Give Calcium-channel blockers