Peripheral Vascular SystemI ANATOMY

A. FunctionB. Composition of vascular system

1. 3 main types: arteries, veins, & capillaries2. Arteries3. Arterioles4. Capillaries5. Veins6. Venules7. Valves8. Lymph Vessels

C. Blood vessel structure1. 3 layers compose arteries & veins

a. Tunica intimab. Tunica mediac. Tunica adventitia

II PHYSIOLOGYA. Circulation

B. Peripheral vascular resistanceC. Autonomic nervous system

1. Sympathetic nervous system2. Parasympathetic nervous system3. Renin Angiotention regulation (kidneys)4. Temperature

D. Virchow’s TriadE. Aging

III ASSESSMENTA. HistoryB. Assessment

1. Pain2. Pulses

Palpable pulse rating scale:0, absent1+, intermittent & barely palpable2+, weak but constantly palpable3+, normal4+, hyperdynamic & occasionally visible

3. Edema

Rating scale:0, none 0secs1+, 2mm 15secs2+, 4mm 30secs3+, 6mm 1min4+, 8mm >2min

4. Capillary refill 5. Homan’s Sign6.Allen’s Test 7. Bruits8. Gait9.Integumentary10. Mnemonic for S/S arterial occlusion (5 P’s)

a. Painb. Pallorc. Pulselessnessd. Paresthesiae. Paralysis

11. Mnemonic for uniform vein & artery assessment & documentationa. PATCHES

P=pulses A=appearance T=temperature C=capillary refill H=hardness E=edema S=sensation

IV DIAGNOSTIC TESTS AND PROCEDURESA. Doppler ultrasound (Duplex Scanning)B. PlethysmographyC. Pressure measurementD. Exercise treadmill (stress test) E. AngiographyF. I-fibrinogen uptake testG. Abdominal ultrasoundH. Contrast enhanced CT or MRII. Lab TestJ. CXR

V TREATMENT MODALITIESA. Reduction of Risk FactorsB. Exercise and positioningC. Pain managementD. TED (antiembolism stockings)E. SCD (sequential compression devices)F. ThermotherapyG. Embolectomy or ThrombectomyH. Percutaneous transluminal angioplasty (PTA)I. EndarterectomyJ. SympathectomyK. Vein ligation and strippingL. Arterial bypass graftM. AmputationN. Sclerotherapy

VI VASCULAR DRUGSA. Antihypertensives

1. Diuretic2. Betablocker3. Ca+ channel blockers4. ACE inhibitors5. Angiotension II receptor antagonists

6. CNS agents7. Alpha-adrenergic agents8. Vasodilators & Nitrates

AnticoagulantsAntiplatelet agents

D. ThrombolyticsE. Hemorrheologic agents

VII DIEASE PROCESSESA. Hypertension

1. Classifications of HTN

a. Primary or essential HTN

b. Secondary HTN

c. Malignant HTN or HTN crisis

d. Isolated Systolic Hypertension

e. Orthostatic Hypotension

f. Stages of HTN Prehypertension 120-139/80-89 Stage 1 140-159/90-99 Stage 2 160-179/100 or greater

g. Risk Groups

Group A – no cardiovascular risk factors or conditions & Group B – One cardiovascular risk factor but no diabetes or other risk conditions Group C – Diabetes and/or any of the other risk conditions

2. Step Program Step 1 (life style changes) Step 2 (thiazide-type diuretic) Step 3 (addition of another class of drug like beta-blocker, ACE inhibitor, or Ca+

channel blocker) Step 4 (addition of another drug like Ca+ channel blocker or ACE inhibitor)

B. PVD (peripheral vascular disease)

1. Differentiation of terms

a. Thrombus

c. Embolus

d. Thromboemboli

e. Phlebitis

f. Thrombophlebitis

g. Phlebothrombosis

2. Virchow’s Triad

C. S/S of Arterial vs. Venous disordersArterial Venous

Pain (acute) Sharp pain Aching, deep muscle pain

Intermittent Claudication Relieved by activity or elevation(Chronic) cramping w/ exercise, heaviness, leg fatigueRelieved by rest

Pulses Diminished or absent PresentBruit over arteries

Edema Absent Present; increases at end of day & extremitydependent

Skin Changes Cool or cold WarmDry, shiny, scaling, thin Thick, toughenedHairlessPallor develops w/ elevation Rubor, darkened pigmentationErythematous w/ dangling Varicose veinsCyanotic Stasis ulcers

D. Arterial Occlusive Disorders (deprive O2 to a tissue or body part) 1. Arteriosclerosis Obliterans (chronic arterial insufficiency)

2. Raynaud’s Disease

3. Buerger’s Disease

4. Arterial Embolism (acute arterial insufficiency)

5. Aneurysms

6. Aortic Dissections

7. Carotid Artery Stenosis

8. Arterial Trauma

F. Venous Disorders1. Thrombophlebitis (venous thrombus)

2. DVT (deep vein thrombosis)

3. Varicose veins (varicosities)

4. Chronic venous insufficiency

5. Venous Stasis Ulcers