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VASCULAR SYSTEM AND HEMATOLOGY

389

Table 6-1-1. Differentiaring True Incerminent Claudication from

Pseudoc1audication

Charactcristic of

Incerminem

Discomfort

Claudication

Pseudoclaudication

Acrivity-induced

Yes

Yes or no

Location

Unilateral buttock,

Back pain and bilathip, thigh, calf and

eral leg pain

foar

Narure

Cramping

Same as with intermitlightness

tent claudication or

Tircdness

presence of tingling, weakness,

and clumsiness

Occurs with standing

No

Yes

Onset

Occurs at the same

Occurs at variable disdistance each time

tance each time

with walking on

with walking on

level surface

level surfaces

Unchanged or

Increased distance

decreased distance

when walking uphill

walking uphill

Unchanged or

Decreased distance

increased distance

walking downhill

walking downhill

Relieved by

Stopping activity

Sitting

Sources: Data from JR Young, RA Graor, j\'V Olin, JR Bartholomew (eds). Peripheral

Vascular Diseases. St. Louis: Mosby, 1991; 183; and JM Fritz. Spinal Stenosis. In JD

Placzck, DA Boyce (eds). Orthopacdic Physical Therapy Secrets. Philadelphia: Hanley

& Helfu,. 2001;344.

• Genetic abnormality in collagen (e.g., with Marfan's syndrome)

• Aging and natural degeneration of elastin

•

Increased proteolytic enzyme activity

• Atherosclerotic damage to elastin and collagen

A true aneurysm is defined as a 500/0 increase in the normal diameter of the vessel" and involves weakening of all three layers of the arterial wall. True aneurysms are also generally fusiform and circum-

390 ACUTE CARE HANDBOOK FOR PHYSI AL THERAPISTS

ferential in nature. False and saccular aneurysms are the result of

trauma from dissection (weakness or separation of the vascular layers) or clot formation. They primarily affect the adventitial layer."

Figure 6-2A and C demonstrate fusiform and saccular aneurysms,

and Figure 6-2B illustrates an arterial dissection.

Abdominal aneuryms may present with vague abdominal pain but

are relatively asymptomatic until an emboli dislodges from the aneurysm or the aneurysm ruptures 22 Aneurysms will rupture if the intraluminal pressure exceeds the tensile strength of the arterial wall.

The risk of rupture increases with increased aneurysm size.13

Clinical Tip

Abdominal aortic aneurysms are frequently referred to as

AAA or Triple A in the clinical setting.

The following are additional clinical manifestations of aneurysms:

•

Ischemic manifestations, described earlier, in Atherosclerosis, if

the aneurysm impedes blood flow.

• Cerebral aneurysms, commonly found in the circle of Willis,

present with increased intracranial pressure and its sequelae (see

General Management in Chapter 4 for more information on inrracranial pressure).!1

• Aneurysms that result in subarachnoid hemorrhage are also discussed in Chapter 4.

• Low back pain (aortic aneurysms can refer pain to the low

back).

• Dysphagia (difficulty swallowing) and dyspnea (breathlessness)

resulting from the enlarged vessel's compressing adjacent organs.

Surgical resection and graft replacement are generally the desired

treatments for aneurysms.2J However, endovascular repair of abdominal aneurysms is demonstrating favorable results. Endovascular repair involves threading an endoprosthcsis through the femoral

artery to the site of the aneurysm. The endoprosthesis is then attached

ro the aorta, proximal to the sire of the aneurysm, and distal, to the

iliac arteries. This effectively excludes the aneurysm from the circularion, which minimizes the risk of ruprure.22 Nonsurgical candidates must have blood pressure and anticoagulation managemenr.2J