PHERIPHERAL VASCULAR DISEASE.
DEFINITION
– PHERIPHERAL VASCULAR DISEASE
(PVD) is the group of disorder affecting artery , veins , capillaries, and lymphatic system.
– Thus affecting the cellular organs , body nutrients , metabolism and health.
• Disease of Arteries
– Acute arterial occlusion
– Chronic arterial insufficiency
√ Atherosclerosis
√ Arteriosclerosis
√ TAO / buerger’s disease
√ Raynauds disease
√ Aneurysm
• Disease of veins
√ DVT
√ Vericose veins
√ Thrombophlebitis
√ Lymphedema
• Disease of Arteries :
1) Acute arterial occlusion
– Sudden cessation of blood flow usually requires emergency surgical intervention.
2) Atherosclerosis
– Thickening and hardening of large and medium sized muscular artery , due to tunica intima involvement and is characterized by atheroma.
3) Arteriosclerosis
– Due to degenerative conditions there will be thickening and hardening of arterial walls
– It includes :
√ Senile arteriosclerosis
√ Hypertensive arteriosclerosis
√ Monckebergs arteriosclerosis
√ Atherosclerosis
4) TAO
– Inflammatory occlusive disorder of small and medium sized arteries and veins in distal upper and lower extremity.
– 3 grades of claudication
(A) Grade 1 – pain on walking , on continuing walk, pain subsides.
(B) Grade 2 – Pain on walking , on continuing walk, pain increases.
Patient has to take rest for relief of pain.
(C) Grade 3 – Rest pain
.
5) Raynauds disease
– It is characterized by Sequential development of white, numb , dead fingers and cyanosis, Rubor of fingers on exposure to cold and subsequent flushing phase due to rewarming.
• Disease of veins :
1) DVT
– It is formation of thrombus in the deep veins of lower limb.
• Etiology : Virchow’s triad.
• Clinical features :
√ Cramp like pain
√ Heaviness in limb
√ Tenderness
√ Ankle edema
√ Mild fever
√ Pleuritic pain
√ Tachycardia
√ Palpitation
√ Breathlessness
√ Signs of shock.
• Special tests :
(A) Homan’s sign
– Passive Dorsiflexion of ankle with knee in extension will elicit pain in calf muscles.
(B) Trendlenberg test
(C) Perthe’s test
2) Varicose veins
– Engorged, dilated , tortuous and elongated vein is called as Varicose veins.
• Special tests
(A) Brodie Trendlenberg test
√Trendlenberg test 1
– Here, the vein is made empty by elevation of limb and tornique is applied just below saphenofemoral junction.
– Patient is asked to stand quickly when tornique is released rapid filling from above signifies saphenofemoral incompitence.
√ Trendlenberg test 2
– Here, after standing tornique is not removed
– Filling of blood from below upwards rapidly can be observed within 30-60 seconds.
– It signifies perforator incompitence.
(B) Perthe’s Test
– The affected lower limb is wrapped with elastic bandage and then ask the patient to walk and exercise.
– Development of severe cramp like pain in calf indicates DVT
(C) 3 tornique test
(D) sehwartz test.
3) Thrombophlebitis
– It is a inflammatory disease of the inner walls of superficial veins , mainly of lower limb.
4) Lymphedema
– It is the collection of lymph in Subcutaneous tissue due to abnormalities in the lymphatic system .
– 2 types : Primary and secondary.
• PT management
Aims :
– To relieve pain
– To reduce edema.
– To improve circulatory and respiratory function.
– To improve ambulation.
– To improve functional activities
– To prevent complication and Infection
– To prevent recurrance
– Promote healing and improve circulation.
(1) General care
– Stop smoking
– Prevent injury to limbs
– Advise patient to wear socks and shoes
– Avoid risk factors
– Reduce weight
– Bed rest
(2) Respiratory care
– Deep breathing exercises
– Diaphragmatic breathing
– Chest expansion exercise
– Huff and coughing technique
– postural drainage
(3) Circulatory exercise
– Ankle toe movements
– Active movements of upper and lower limbs
– Isometric exercise
– patient must do vigorous exercise 4-5 times / day
– Do not sit / stand for prolonged time.
(4) Postural awareness
– Prevent kyphotic and scoliotic posture
– Maintain erect posture
– Use of mirror
– Pelvic tilting exercise
(5) Buerger’s exercise
(6) Contrast bath
– Dip the affected limb in hot water for 3 mins , then in cold water for 1 min
– This improves circulation and also relieves pain
(7) Function training
– Aerobic exercise
– Advice to improve cardiovascular fitness
– Walking in corridor
– Stair climbing
– Relaxation techniques
– Early ambulation exercise.
(8) Home program
– Patient should check the skin Temperature , colour, signs of DVT in lower limb everyday
– Avoid movement of joints in the area of graft.
– Regular exercise
– Wear elastic stockings.
