LECTURE 8 VASCULAR DISORDERS

1. LECTURE 8 VASCULAR DISORDERS Vascular disorders which causes disturbances of circulation to the extremities can result in significant loss of function either in the upper or lower extremities. Disturbances of circulation may be caused by a number of acute or chronic medical conditions known as peripheral vascular diseases (P V Ds) which can affect the arterial, venous or lymphatic circulatory systems.

2. Physical therapist must have a sound understanding of these types of disorders and the associated physical impairments. In addition the therapist must be aware of the use and effectiveness as well as the limitations of therapeutic ex. in the evaluation and rehabilitation of patients with vascular disorders.

3. ARTERIAL DISORDERS: 1-Acute arterial occlusion: by a thrombus (blood clot, embolism or trauma to an artery. -The most common location of an arterial embolism is at the femoral popliteal bifurcation. -An occlusion result in absent or diminished pulses and complete or partial interruption of circulation to an extremity. The severity of the problem is dependent upon the location and size- of the occlusion and the availability of collateral circulation. If little or no collateral circulation is available, an acute arterial occlusion will cause tissue ischemia and possibly gangrene of the distal limb.

4. 2-Chronic arterosclerotic vascular disease (A S V D) also called arteriosclerosis obliterans (A S O) or a progressive arterial occlusive disease (P A O D). This disease is most often seen in elderly patients and is commonly associated with D.M.

5. 3-Thromboangitis obliterans (Buerger´s disease): -This chronic disease, which seen in young, male patients who smoke, involves an inflammatory reaction of the arteries to nicotine. -It is occurs in the small arteries of the feet and hands and progresses proximally and results in vasoconstriction decreased arterial circulation to the extremities, ischemia, and eventual necrosis and ulceration of soft tissues.

6. 4-Raynaud´s disease (Raynaud´s phenomenon): -This functional arterial disease is caused by vasospasm; most often affecting the arterioles and small arteries of the fingers. It is caused by an abnormality of the sympathetic nervous system and is usually seen in young adults.

7. It is characterized by:- Sensitivity to cold, cyanosis of the fingers tips and nail beds, sever pain sensory loss (tingling or numbness), decreased functions of the hands. Symptoms are slowly relieved by warmth.- Sings and Symptoms:- Changes in skin color and temperature.- Sensory disturbances. Pain and paralysis.-

8. TTT of acute arterial diseases: Medical or Surgical Medical including: bed rest and anticoagulant therapy.- Surgical including: thromboembolectomy.- Physical including: reflex heating of the torso or opposite extremity.- positioning and protect the limb. Precautions:- Local and direct heat of the extremity is contraindicated because it can cause a burn to ischemic tissues.

9. TTT of chronic arterial diseases: Medical or Physical -Improve ex. tolerance for A D L by regular, graded aerobic ex. program of walking or bicycling. -Improve vasodilatation by Iontophoresis also by reflex heating. -Relieve pain at rest; sleep with the legs in a dependent position over the edge of the bed or with the head of the bed slightly elevated. Prevent skin ulceration.- Prevent joint contractures and muscle atrophy.- Promote healing of any skin ulceration.-

10. VENOUS DISORDERS:- Types:-Acute thrombophlebitis (superficial and deep venous thrombosis) Chronic venous disorders (various venous and chronic venous insufficiency). Sings and Symptoms:- -Patients with acute thrombophlebitis have pain, swelling and tenderness of the calf muscle .Also inflammation and discoloration of the extremity. -Patients of chronic venous insufficiency have dependent edema associated with standing and sitting for prolonged period of time. Aching or tiredness in the legs. Increased pigmentation and stasis of the limb. Skin ulcerations and secondary infection which can lead to cellulites.

11. TTT of acute thrombophlebitis:- Relieve of pain by application of moist heat.- -Graded ambulation with legs wrapped in elastic bandage or when pressure gradient support stocking are worn. -Prevent recurrence of the acute disorder by asking patient to avoid sitting or standing for a long period of time.

12. TTT of chronic venous disorders:- -Increase venous return and reduce edema by wearing support stoking, manual massage, using intermittent compression pump, elevation of the feet during rest. -Regular active ex. -Prevent skin ulceration and wound infection by proper skin care.

13. LYMPHATIC DISORDERS:- LYMPHEDEMA is an excessive accumulation of extravascular and extracellular fluid in tissue spaces. It is caused by a disturbance of the water and protein balance across the capillary membrane. Types: a- Primary or congenital obstruction of the lymphatic system. b-An obstruction of the lymphatic system secondary to trauma or infection (cellulites) of extravascular tissues.

14. Sings and Symptoms:- -There is pain; less swelling of the distal extremity. it is most often seen over the dorsum of the hand or foot. -Increased weight or heaviness of the extremity, sensory disturbances hand or foot). -Stiffness of fingers or toes. -Decreased resistance to infection, causing frequent episodes of cellulites.

15. TTT of lymphedema: Prevention is the best goal.- -Treat the cause. -Reduce lymphedema by intermittent mechanical compression, by a pneumatic pump and sleeve or bag for several hours daily. -Elevation of the extremity above the level of the heart (about 30 to 45 degrees) while sleeping. -Manual massage from distal to proximal along the length of the limb. -Prevent further edema by using elastic supported stocking or sleeve, regular ex., regular elevation of the extremities, application of local heat. -Prevent infection and cellulites by care of the skin abrasions. -Used antibiotics.