Peripheral Vascular System

I ANATOMY
A. Function
B. Composition of vascular system
1. 3 main types: arteries, veins, & capillaries
2. Arteries
3. Arterioles
4. Capillaries
5. Veins
6. Venules
7. Valves
8. Lymph Vessels
C. Blood vessel structure
1. 3 layers compose arteries & veins
a. Tunica intima
b.
Tunica media
c. Tunica adventitia
II PHYSIOLOGY
A. Circulation

B. Peripheral vascular resistance

C. Autonomic nervous system
1. Sympathetic nervous system
2. Parasympathetic nervous system
3. Renin Angiotention regulation (kidneys)
4. Temperature
D. Virchows Triad
E. Aging
III ASSESSMENT
A. History
B. Assessment
1.
Pain
2. Pulses
Palpable pulse rating scale:
0, absent
1+, intermittent & barely palpable
2+, weak but constantly palpable
3+, normal
4+, hyperdynamic & occasionally visible
3. Edema

Rating scale:
0, none
0secs
1+, 2mm
15secs
2+, 4mm
30secs
3+, 6mm
1min
4+, 8mm
>2min
4. Capillary refill
5. Homans Sign
6.Allens Test
7. Bruits
8. Gait
9.Integumentary
10. Mnemonic for S/S arterial occlusion (5 Ps)
a. Pain
b. Pallor
c. Pulselessness
d. Paresthesia
e. Paralysis
11. Mnemonic for uniform vein & artery assessment & documentation
a. PATCHES
P=pulses
A=appearance
T=temperature
C=capillary refill
H=hardness
E=edema
S=sensation
IV DIAGNOSTIC TESTS AND PROCEDURES
A. Doppler ultrasound (Duplex Scanning)
B. Plethysmography
C. Pressure measurement
D. Exercise treadmill (stress test)
E. Angiography
F. I-fibrinogen uptake test
G. Abdominal ultrasound
H. Contrast enhanced CT or MRI
I. Lab Test
J. CXR

V TREATMENT MODALITIES
A. Reduction of Risk Factors
B. Exercise and positioning
C. Pain management
D. TED (antiembolism stockings)
E. SCD (sequential compression devices)
F. Thermotherapy
G. Embolectomy or Thrombectomy
H. Percutaneous transluminal angioplasty (PTA)
I. Endarterectomy
J. Sympathectomy
K. Vein ligation and stripping
L. Arterial bypass graft
M. Amputation
N. Sclerotherapy

VI VASCULAR DRUGS
i. Antihypertensives
1.
2.
3.
4.
5.

Diuretic
Betablocker
Ca+ channel blockers
ACE inhibitors
Angiotension II receptor antagonists

6. CNS agents
7. Alpha-adrenergic agents
8. Vasodilators & Nitrates
Anticoagulants
Antiplatelet agents
D. Thrombolytics
E. Hemorrheologic agents
VII DIEASE PROCESSES
A. 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
Stage 1
Stage 2
g. Risk Groups

120-139/80-89
140-159/90-99
160-179/100 or greater

 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.

Virchows Triad

C. S/S of Arterial vs. Venous disorders

Arterial
Pain
(acute) Sharp pain

Venous
Aching, deep muscle pain

Pulses
Edema

Intermittent Claudication
(Chronic) cramping w/ exercise,
Relieved by rest
Diminished or absent
Bruit over arteries
Absent

Skin Changes Cool or cold

Dry, shiny, scaling, thin
Hairless
Pallor develops w/ elevation
Erythematous w/ dangling
Cyanotic

Relieved by activity or elevation

heaviness, leg fatigue
Present
Present; increases at end of day & extremity
dependent
Warm
Thick, toughened
Rubor, darkened pigmentation
Varicose veins
Stasis ulcers

D. Arterial Occlusive Disorders (deprive O2 to a tissue or body part)

1. Arteriosclerosis Obliterans (chronic arterial insufficiency)
2. Raynauds Disease
3. Buergers Disease
4. Arterial Embolism (acute arterial insufficiency)
5. Aneurysms
6. Aortic Dissections
7. Carotid Artery Stenosis
8. Arterial Trauma
F. Venous Disorders
1. Thrombophlebitis (venous thrombus)
2. DVT (deep vein thrombosis)
3. Varicose veins (varicosities)
4. Chronic venous insufficiency
5. Venous Stasis Ulcers