Vascular Diseases

The rehabilitation professional is often asked to evaluate a patient with a painful, swollen, or ulcerated limb. A sound understanding of vascular disease is essential in order to make the correct diagnosis and treatment plan. Arterial, venous, or lymphatic dysfunction may be the primary issue or a critical comorbidity in many patients who present to rehabilitation. A detailed history, examination, and selected diagnostic tests should be inherent in the rehabilitation evaluation. The arterial evaluation may include segmental pressures, Doppler waveform analysis, and ankle-brachial index with duplex ultrasonography to locate and categorize peripheral arterial disease. Imaging studies include computed tomography angiography and magnetic resonance angiography for more accurate location and measurements of arterial pathology. If a patient is found to have peripheral arterial disease, the current recommendations are to treat with antiplatelet therapy, stop smoking, exercise, and be screened and treated for hyperlipidemia, hypertension, diabetes, and hypercoagulability. Venous disease workup may include duplex ultrasound to localize obstruction and detection of valvular reflux. Compression is the mainstay of treatment and can be supplemented with elevation and exercise. Intermittent pneumatic compression may be added if there is no history of congestive heart failure or venous obstruction.Lymphedema can be classified as primary or secondary and can be determined by lymphoscintigraphy. Treatment for lymphedema includes good skin care, treatment of infections, specialized massage techniques, compression, elevation, and exercises. When vascular disease is identified early, noninvasive treatments may ameliorate the need for more aggressive medical and surgical treatments.