Peripheral Vascular Disease (PVD)

Peripheral Vascular Disease (PVD)

1. Etiology/Risk Factors

   • Coronary Artery Disease (Newman et al., 2017)
   • Diabetes (Newman et al., 2017)
   • Irregular anatomy of muscles or ligaments
   • Age (especially over 50)
   • Male gender
   • Postmenopausal women
   • Family history
     • PVD
     • high cholesterol
     • hypertension
   • Obesity
   • Physical inactivity
   • Smoking

2. Disease Process

   • Affects (Stanford Medicine, 2017)
     • Arteries
       • Peripheral Arterial Disease
     • Lymphatic vessels
       • Lymphedema
     • Veins
       • deep vein thrombosis (Figure 1), varicose veins, chronic venous insufficiency
         • Figure 1

3. Narrowing of blood vessel circumference (Johns Hopkins University, 2017)

   • decreased blood flow to and from tissue
     • decreased oxygen and nutrient transport in periphery
       • Figure 2, example of substances transported to and from tissue

4. Types (American Heart Association, 2015)

   • Functional
     • No defects in blood vessel structure
       • May be due to intermittent spasms
   • Organic
     • Structural changes to blood vessels
       • May be due to inflammation and tissue damage

5. Treatment (Johns Hopkins University, 2017)

   • Bypass graft surgery (Figure 3)
     • Reroutes blood flow from a narrowed blood vessel
     • Figure 3
   • Medications
     • Widening of blood vessels and improved blood flow
   • Of existing diseases, especially those that directly affect PVD
     • Diabetes
     • Coronary Artery Disease
   • Angioplasty (Figure 4)
     • Catheter inserted to increase circumference of blood vessel
     • Figure 4

6. Disease Prevention (Johns Hopkins University, 2017)

   • Smoking cessation
   • Diet modifications
     • Decreased fat intake
   • Weight loss
   • Limited alcohol intake
   • Manage existing diseases

7. Diagnosis

   • Signs & Symptoms (Lewis, Bucher, Heitkemper, Camera, 2013)
     • Intermittent Claudification
       • Figure 6
     • Pain at rest of lower extremities
     • Cold feet
     • Delayed capillary refill >3 seconds
     • Dependent rubor - redness of skin when extremity is in dependent position
     • Loss of hair
   • Complete Medical History (Stanford Medicine, 2017).
   • Ankle-brachial Index - non invasive vascular screening test which compares systolic BP in the ankle to brachial systolic BP (estimates central BP) (Maggi, Quadros, Azzolin, & Goldmeier 2014).
     • Normal finding is 0.9-1.3 (Maggi, Quadros, Azzolin, & Goldmeier 2014).
       • Figure 5
   • Angiography - Contrast dye is released into the an artery in the leg, allows the blood flow in the arteries and veins to be visible on X-ray (Stanford Medicine, 2017).
   • Doppler Instrument - amplifies sound and measures blood flow velocity in lower extremities (Lewis, Bucher, Heitkemper, Camera, 2013)

8. Nursing Care

   • Aid with hygiene - wash feet daily with mild soap/water, dry feet adequately, especially between toes (Lewis et al., 2013).
   • Client-Centred-Care (CNO, 2006).
     • Individualized plan of care - work with pt. and family to make care plan unique to their circumstances
     • Respecting/Listening to client values and opinions
     • Advocating for client based on their wishes that have been discussed
   • Client Teaching (Lewis et al., 2013).
     • Inspect feet daily, help client in doing so if eyesight is poor or limited mobility
     • Avoid open-toe,open-heel shoes, and bare feet
     • Exercise feet and legs daily
       • Walking is recommendd
       • Avoid prolonged sitting, standing, crossing of legs
     • Wear socks for warmth, avoid using heating pads
       • to avoid causing tissue damage

9. Complications (due to decreased/absent blood flow) (Stanford Medicine, 2017).

   • Myocardial Infarction
     • Increased risk of lack of/decreased blood flow to the heart
   • Poor wound healing - decreased oxygen perfusion of the tissue
   • Severe pain in affected extremity
     • Restricted mobility due to pain/discomfort
   • Cerebrovascular Accident
     • 3x more likely in people with PVD
       • Figure 7
   • Pressure Ulcers - Decreased oxygen perfusion to the tissue
   • Amputation (in severe cases)
     • To prevent spread of necrotic tissue

Images and files in the map