Vascular disorders reduce blood flow to tissues (arterial disease) or impair blood return from tissues (venous disease). Telling the two apart guides positioning, wound care, and teaching.

Arterial disorders

• Peripheral artery disease (PAD) — atherosclerosis narrows leg arteries, causing ischemia with exercise (intermittent claudication) and, when severe, at rest. Risk factors match those of CAD: smoking (strongest), diabetes, hypertension, dyslipidemia, age, chronic kidney disease
• Acute arterial occlusion (acute limb ischemia) — sudden blockage by an embolus (often from the heart in atrial fibrillation) or thrombosis on a plaque. Tissue can die within hours — a vascular emergency
• Thromboangiitis obliterans (Buerger disease) — inflammatory occlusion of small and medium arteries and veins of the hands and feet, almost always in young smokers (typically men under about 45)
• Raynaud phenomenon — episodic spasm of digital arteries triggered by cold or emotional stress. Primary (no cause) or secondary (e.g., scleroderma, lupus)
• Abdominal aortic aneurysm (AAA) — dilation of the abdominal aorta (diameter ≥ 3 cm); risk factors: smoking, male sex, age over 65, family history, hypertension. Risk of rupture rises with size
• Aortic dissection — a tear in the aortic intima lets blood split the wall layers. The false channel can block branch arteries (to brain, arms, kidneys, gut, legs) or rupture. Type A (ascending aorta) is a surgical emergency; type B (descending only) is often treated medically. Uncontrolled hypertension is the main risk factor

Venous disorders

• Deep vein thrombosis (DVT) — clot in a deep vein, usually of the leg. Virchow's triad: venous stasis (immobility, long travel), vessel wall injury (surgery, trauma), hypercoagulability (cancer, pregnancy, estrogen, inherited disorders, dehydration). Main danger: pulmonary embolism (PE)
• Chronic venous insufficiency (CVI) — damaged valves let blood pool in the legs → venous hypertension, edema, skin changes, and venous ulcers
• Varicose veins — dilated, tortuous superficial veins

Arterial vs. venous disease

Acute arterial occlusion — the 6 Ps: pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (cold limb). Paresthesia and paralysis signal a threatened limb.

Buerger disease: foot or arch claudication, rest pain, cold sensitivity, ulcers and gangrene of fingers and toes, superficial thrombophlebitis.

Raynaud: color change white (pallor) → blue (cyanosis) → red (rubor on rewarming), with numbness, tingling, throbbing.

DVT: unilateral leg swelling (measure calf circumference), pain or tenderness, warmth, redness. Many DVTs are silent. Homans' sign (calf pain on dorsiflexion) is unreliable and should not be used to diagnose DVT.

AAA: often asymptomatic; pulsatile abdominal mass, abdominal bruit. Back, flank, or abdominal pain suggests expansion; rupture causes severe pain, hypotension, and shock.

Aortic dissection: sudden, severe "tearing" or "ripping" chest or back pain; unequal pulses or a systolic BP difference of more than 20 mmHg between arms; syncope, stroke signs, new aortic regurgitation murmur, decreased urine output, abdominal pain, limb ischemia.

PAD

• Smoking cessation and supervised exercise therapy (walk until moderate claudication, rest, repeat; about 30–45 minutes, at least 3 times weekly for 12 weeks)
• Antiplatelet (aspirin or clopidogrel) and high-intensity statin; low-dose rivaroxaban with aspirin for selected clients; control BP and diabetes
• Cilostazol for claudication — contraindicated in heart failure of any severity; headache, diarrhea, palpitations
• Revascularization (angioplasty, stent, bypass) for limiting claudication or limb-threatening ischemia

Acute limb ischemia: immediate IV heparin (per order) to stop clot extension, and urgent revascularization (embolectomy, catheter-directed thrombolysis, bypass).

Buerger disease: complete abstinence from all tobacco and nicotine products is the only treatment that halts progression; wound care; amputation if gangrene progresses.

Raynaud: avoid triggers; dihydropyridine calcium channel blocker (nifedipine, amlodipine) for frequent attacks — headache, flushing, ankle edema, hypotension.

DVT

• Anticoagulation for at least 3 months. Direct oral anticoagulants (apixaban, rivaroxaban) are preferred for most clients; alternatives: low-molecular-weight heparin (enoxaparin), unfractionated heparin (monitor aPTT or anti-Xa), or warfarin overlapped with a parenteral agent for at least 5 days and until INR ≥ 2.0 for 24 hours
• Early ambulation is safe once anticoagulation has started — strict bed rest is not needed
• IVC filter only when anticoagulation is contraindicated
• Apixaban and rivaroxaban can start without a parenteral lead-in; dabigatran and edoxaban need at least 5 days of parenteral anticoagulation first
• DOAC safety: bleeding, dose by kidney function, do not skip doses (short half-life); avoid in pregnancy, with mechanical valves, and in antiphospholipid syndrome; see Dysrhythmias topic for reversal. LMWH is the anticoagulant of choice in pregnancy
• Heparin safety: watch for bleeding and heparin-induced thrombocytopenia (HIT) — platelets fall by more than 50%, usually 5–10 days after starting (within 24 hours if heparin was given in the past 100 days). HIT is prothrombotic: stop all heparin (including flushes and heparin-coated lines) and report; a non-heparin anticoagulant (e.g., argatroban, fondaparinux, or a DOAC) is started; do not start warfarin until platelets recover; platelet transfusion is generally avoided. Protamine reverses heparin (only partially reverses enoxaparin). Enoxaparin: adjust for kidney impairment; do not expel the air bubble or rub the site
• Warfarin safety: INR target 2.0–3.0; many interactions; vitamin K reverses it; teratogenic

Chronic venous insufficiency and ulcers

• Compression therapy is the foundation — reduces venous pressure and edema and promotes healing. Check arterial flow (ABI) first, because compression can injure an ischemic leg
• Moist wound healing dressings, leg elevation, calf-muscle exercise; avoid harsh antiseptics and sharp debridement by untrained staff; endovenous ablation or sclerotherapy for varicose veins

AAA: smoking cessation, BP control, ultrasound surveillance. Repair (endovascular aneurysm repair — EVAR — or open surgery) usually at 5.5 cm or more in men (about 5.0 cm in women), rapid growth, or symptoms. Rupture: emergency surgery.

Aortic dissection: IV beta blocker first (esmolol, labetalol) to lower heart rate and the force of ejection, then a vasodilator if BP remains high — commonly targeting systolic BP below 120 mmHg and heart rate 60–80/min. Opioid for pain. Type A: emergency surgery.

Listed in priority order.

1. Acute limb ischemia — report immediately and prepare for heparin and revascularization; keep the limb level or slightly dependent; protect from pressure; do not elevate, massage, or apply heat or cold. Check pulses (Doppler), color, temperature, sensation, and movement frequently. After reperfusion, watch for compartment syndrome (pain on passive stretch, tense swelling)
2. Aortic dissection — continuous monitoring of BP (both arms), heart rate, peripheral pulses for symmetry and strength, neurologic status, urine output, and abdominal pain; titrate IV drugs; prepare for surgery
3. After AAA repair — maintain BP in the ordered range (hypotension threatens graft patency; hypertension stresses suture lines); check distal pulses, hourly urine output (renal ischemia), bowel sounds, bloody diarrhea (bowel ischemia), and leg strength (spinal cord ischemia). Encourage coughing, deep breathing, and incentive spirometry to prevent atelectasis and pneumonia; early mobilization. After EVAR: access-site bleeding and leg pulses
4. DVT — anticoagulation safety; never massage the affected leg; elevate for swelling; watch for PE (sudden dyspnea, chest pain, tachycardia, anxiety)
5. DVT prevention — early ambulation, ankle pumps, hydration, intermittent pneumatic compression, pharmacologic prophylaxis as ordered
6. PAD — position legs slightly dependent; meticulous foot inspection; no heating pads; protect heels
7. Venous ulcer — maintain compression, elevate legs above heart level when resting, moist dressings

• Stop smoking — essential for PAD, Buerger disease, aneurysm, and Raynaud
• PAD: walk daily through mild–moderate pain, then rest; inspect feet daily; wear well-fitting shoes; never walk barefoot; avoid heating pads, tight garters, and crossing legs
• Raynaud: wear gloves and socks in cold weather; avoid cold exposure (including air conditioning and cold objects); limit caffeine and avoid decongestants; manage stress; during an attack, warm hands with warm (not hot) water or in the armpits
• DVT prevention: avoid prolonged sitting; on long flights or drives, walk and do calf exercises, drink water, and avoid alcohol; wear compression stockings if advised
• CVI: wear compression stockings daily (apply in the morning before swelling); elevate legs; avoid prolonged standing
• Warfarin: take at the same time daily; regular INR tests; keep vitamin K intake consistent — do not stop eating green vegetables; check before starting any drug, supplement, or herbal product; report bleeding gums, nosebleeds, easy bruising, dark urine or stools; use a soft toothbrush and electric razor; wear medical identification
• AAA: report new back, flank, or abdominal pain immediately; keep BP controlled

• Arterial: dangle legs, pale, hairless, painful ulcers on toes; venous: elevate legs, edema, brown skin, ulcers at medial ankle
• ABI ≤ 0.90 = PAD
• Acute limb ischemia (6 Ps) = emergency: report, heparin, revascularization; keep limb level/slightly dependent — no heat, no elevation
• Buerger disease = young smoker, digital ulcers and gangrene; only cure is stopping tobacco
• Raynaud: white–blue–red; keep warm, gloves; avoid cold and stimulants
• Venous ulcer: compression therapy (after confirming arterial flow)
• DVT: no massage, anticoagulate, early ambulation once anticoagulated; Homans' sign is unreliable
• Long flights: move, hydrate, avoid alcohol
• Warfarin: consistent vitamin K, INR 2.0–3.0
• Aortic dissection: tearing pain, unequal pulses/arm BPs; beta blocker first
• After AAA repair: urine output, pulses, cough and deep breathing