超級無敵面包攻略pvd

1、Peripheral Vascular Disease (PVD)Acknowledgement: Modified from slides prepared by Ms Shamay Ng Peripheral Vascular DiseasePeripheral ArterialVenous diseases Structure of Blood VesselsPeripheral Arterial DiseasesArteriosclerosis AtherosclerosisAneurysmBuergers diseaseRaynauds diseasePeripheral Venou

2、s Diseases Deep Vein ThromboisPresence of a thrombus in a deep vein Varicose VeinsResult from valvular degeneration (hereditary)ArteriosclerosisDegenerative arterial diseasesHardening of arteries (elastic tissues are replaced by fibrous tissues)Increase peripheral resistance and raised blood pressur

3、eleading to:Narrowing of arteriesThrombosisAtherosclerosisAtheromatous plaques deposit in the intima layer of the artery narrowing of the blood vessels Blood clots will form more easily further narrowing of the blood vesselsPlaques are liable to break down ulceration of the inner coat of arteries &

4、formation of thrombosisAtherosclerosisRisk factors:SmokingHigh fat and cholesterol dietHyperlipidaemiaDiabetesHypertensionObesityLack of exercisesHigh alcohol intakeAtherosclerosisSigns and symptoms:Intermittent claudicationRest painCold limbsSensory changesSkin changesAtherosclerosisTreatment:Diet

5、controlRegular exercises (enhance collateral circulation)MedicationAdvice limb careCollateral CirculationCollateral Circulation AtherosclerosisPhysiotherapy treatment:Buergers exercise:1. Patients lie supine with legs support in elevation X 2 mins2. Patients sit up with legs dependent x 3 mins3. Pat

6、ients lie with legs horizontal x 5 mins4. Repeat (1) to (3) 4 or 5 times, 3 sessions per dayAneurysmDilation of the arterial wall forming a sac in communication with the vesselCaused by:1. Atherosclerosis2. Syphilis or acute infectionsUsually asymptomaticIf untreated, aneurysms may rupture and this

7、can be life-threateningAneurysmAneurysmTreatment:Resection of the aneurysmReplacement with a prosthetic graftBy-pass graftThromboangitis Obliterans (Buergers Disease)An inflammatory response in the arteries, veins, and nerves with unknown aetiology, which is precipitated by smokingSigns and symptoms

8、:Bluish toes and fingersColdness of the affected limbSevere pain if nerves are inflamedBuergers DiseaseTreatment:Stop smokingDrugs: pain and vasodilationSkin hygienePhysiotherapy:Buergers exerciseRaynauds DiseaseIntermittent spasm of arteries in fingers and toes, causing a lack of blood flow to the

9、affected partsTriggered by: (a) exposure to cold environment(b) emotional disturbanceSigns and symptoms:Fingers turn white and numb, when spasm wears off turns to red, but remains swollen and painful Raynauds DiseaseManagement:Avoid cold extremitiesWarm atmosphereStop smokingSurgery: SympathectomyPh

10、ysiotherapy:General active exercisesContrast bathAssessment of PVDStage 1: Vascular history of symptomsCardiac historySurgical historyPattern of pain LifestyleAssessment of PVDStage 2: Physical assessment for signs of:IschaemiaAbsent pulsesPoor skin nutritionLoss of hairCool temperature of legPalene

11、ss of footCyanosis Decrease mobility of fingers/ toesAssessment of PVDStage 3: Objective measurementAnkle brachial pressure index (ABPI)Doppler ultrasound on ankle arteriesArteriogramAnkle Brachial Pressure Index (ABPI)Patient lying supineMeasure SBP in both armsMeasure SBP in L or R dorsalis pedis

12、and posterior tibial arteries, taking the one has higher readingABPI = Highest ankle pressure Highest brachial pressureDoppler UltrasoundRecords blood flow at various points of patients legDetects severity and location of vessel diseaseArteriogramNeedle and small catheter inserted into the artery at

13、 groinContrast dye injected down the catheterX-ray taken as solution passes along the arteryDetect the extent and location of artery diseaseSurgical Treatment of PVDAngioplastyCatheter with inflated balloon is threaded under x-ray guidance to the site of blocked arteryInflated balloon can :breaks th

14、e plaquepushes the plaque against the artery wallstretches the arterySurgical Treatment of PVDThrombolytic therapyThrombolytic drugs dissolve the clot and restore the blood flowDrugs are administrated through a catheter directly into the clotSurgical Treatment of PVDBypass graftsWhen angioplasty / t

15、hrombolytic therapy failed or insufficient improvement of circulationA bypass is constructed round an obstructed arterySaphenous vein is usually usedFemoro-Popliteal BypassSurgical Treatment of PVDThrombectomy/embolectomyDirect removal of an embolus through an opening in the arteryA catheter with a

16、balloon at the end is passed beyond the embolusThe balloon is then inflated and the catheter is withdrawn, removing embolus and clearing the vesselSurgical Treatment of PVDSympathectomyRemoval of sympathetic nerve supply to a part of the body causing selective vasodilationEffect is not permanentSurg

17、ical Treatment of PVDDirect resection and anastomosisRejoining an artery after the occluded part is removedComplications of SurgeryCoronary thrombosisDeep vein thrombosisRespiratory complicationsWound infectionHaemorrhageGraft obstructionPre-Operative PhysiotherapyRespiratory care:Maximise cardiopulmonary functionMaintain chest clearanceCirculatory care