(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


√ Arteriosclerosis

√ TAO / buerger’s disease

√ Raynauds disease

√ Aneurysm

• Disease of veins


√ 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.




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