Peripheral Vascular Disease. Arterial/Venous: Acute/Chronic. Peripheral Vascular Disease. A term used to describe a group of diseases that involve pathophysiological changes in the “peripheral” arteries (i.e., excluding the coronary arteries) or veins resulting in blood flow disturbances.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Lymphatic system (ducts and nodes)
Modifiable risk factors:
(ie. ischemic limb)
Patients at risk — Based in part upon the above observations, the 2005 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on PAD, which were produced in collaboration with major vascular medicine, vascular surgery, and interventional radiology societies, identified the following groups at risk for lower extremity PAD
percutaneous transluminal angioplasty (PTA) with stent insertion (e.g., isolated lesion)
Femoropopliteal Bypass (Fem-Pop Bypass) for Peripheral Arterial Disease
Deep vein thrombosis
Alterations affect the balance between bleeding and clotting
Vessel wall injury
Venous stasis: immobility or absence of calf muscle pump, paralysis, stroke, anesthesia, immobility due to bedrest, prolonged travel, obesity, pregnancy, restrictive clothing, reduced blood flow, CHF, shock, vasodilation
Thromboprophylaxis is effective, and every inpatient should be risk-stratified….this includes nurses asking the questions!!!!
previous DVT (must identify high risk situations and initiate prophylaxis, for example, LMWH)
Iatrogenic: caused by medical treatment
Remove IV, elevate hand, warm, moist heat, NSAIDs, sometimes anticoagulants
SQ, once daily or BID
No need for routine monitoring (predictable pharmacokinetics)
Poor venous access
stopped once warfarin is therapeutic, dose based on weight, considered therapeutic when the aPTT is 1.5 – 2.5 times the control (normal), IV pump required for continuous infusion
The coagulation cascade has two pathways which lead to fibrin formation. These are the contact activation pathway (also known as the intrinsic pathway), and the tissue factor pathway (also known as the extrinsic pathway). It was previously thought that the coagulation cascade consisted of two pathways of equal importance joined to a common pathway. It is now known that the primary pathway for the initiation of blood coagulation is the tissue factor pathway. The aPTT (Activated Partial Thromboplastin Time [APTT]) in contrast to the PT, measures the activity of the intrinsic and common pathways of coagulation.
The division of the clotting cascade into the intrinsic, extrinsic and common pathways. The prothrombin time (PT) and its derived measures of prothrombin ratio (PR) and international normalized ratio (INR) are measures of the extrinsic pathway of coagulation. INR, the result (in seconds) for a prothrombin time performed on a normal individual will vary according to the type of analytical system employed, INR = (patient PT/mean normal PT)ISI... International Sensitivity Index (ISI)
Patients may not like injections
Pharmacokinetics unclear is not known in certain patients (i.e. pregnancy, obesity, renal impairment)
Can’t reverse it with antidote (protamine)
Reversible Cause 3 months
Warfarin: Oral blood thinner, For DVT/PE, goal is to prevent new clots and to prevent enlargement of existing clot, Does not break down clot, but allows for body to break down clot itself.
IVC: Bleeding, Venous thrombosis at insertion site, Filter migration or misplacement, Perforation of IVC, IVC obstruction due to filter thrombosis
Primary varicose veins (without involvement of the deep veins) often result from a familial or congenital predisposition that leads to loss of elasticity of the vein wall
symptoms may include a mild aching, a feeling of heaviness, muscle fatigue, itchiness, swelling, muscle cramps, especially at night
WARNING, especially at the end!
appear as superficial, with a beefy red to yellow fibrinous granulation tissue, with irregular borders, often exudative, located in the area of the medial or lateral malleolus/anterior tibial area and accompanied by moderate to severe edema