Cardiovascular nurses often focus more on the "cardio" than on the "vascular," so the purpose of this issue of The Journal of Cardiovascular Nursing (15:4) is to update nurses on the exciting advances that have occurred in the area of vascular disease. Over the past decade, there has been a renewed interest in venous disease and an expansion of the role of vascular medicine-rather than simply surgery-in the treatment of arterial disease. Therapy has changed due to a better understanding of the hematologic and biochemical factors that influence these diseases. Moreover, improvements in vascular imaging technology and endovascular intervention have changed the way that vascular diseases are diagnosed and treated.
Vascular disease encompasses a wide array of arterial and venous problems including stroke, abdominal aortic aneurysm, and peripheral arterial disease, as well as acute and chronic venous disease. Because peripheral arterial disease, coronary artery disease, and cerebrovascular disease are all manifestations of atherosclerosis, these three conditions commonly occur together. In fact, because peripheral arterial disease is associated with increased risk of cardiovascular events, it has been identified as a marker for systemic atherosclerosis.
A significant portion of the population is affected by vascular disease. Stroke is the third leading cause of death and the primary cause of adult disability in the United States. There are 4.4 million stroke victims alive today, and 600,000 people suffer new or recurrent stroke each year.1 Carotid artery disease is the single most important risk factor in the development of stroke. Abdominal aortic aneurysm is the 15th leading cause of death overall and the 10th leading cause of death in men over age 55.2 Peripheral arterial disease affects 12% of the general population and 20% of persons older than 70 years.3 Although few people die of peripheral arterial disease, the discomfort and suffering are significant. Further, the mortality rate approaches 30% after 5 years because of death from stroke and coronary artery disease.4 Clearly, vascular disease is a significant contributor to disability and death in the United States.
The systemic nature of vascular disease and the increased risk of cardiovascular events in these patients emphasize the importance of intensive medical management to reduce risks of cardiovascular morbidity and mortality. Thus, education with an emphasis on risk reduction (eg, smoking cessation, maintenance of a normal blood pressure, lipid management, obesity control, and exercise) is critical for all cardiovascular patients. Knowledge of the incidence of recurrent vascular disease after intervention and the influence of risk reduction techniques on recurrence provides nurses with incentive to take an active role in primary and secondary risk reduction education. We must also emphasize the warning signs of stroke, abdominal aortic aneurysm, and lower extremity arterial and venous disease to patients and the community at large.
As can be seen from the table of contents, this issue provides a comprehensive overview of vascular disease and its most current treatment. The lead article by Anderson describes the traditional and the emerging technology of endovascular treatment of abdominal aortic aneurysm. The endoluminal stent graft placed within the aneurysm is currently being evaluated as an alternative to the standard open repair approach. Next, Finkelmeier and Marolda provide an overview of the challenging topic of aortic dissection, a condition that is usually fatal if left untreated. The clinical presentation of aortic dissection is variable and can mimic any number of medical and surgical conditions, but the most common symptom is chest pain.
In the next article, Aquila summarizes the essentials of deep vein thrombosis and gives an update on current management strategies. She highlights the nurse's role in treatment and discusses deep venous thrombosis prophylaxis based on patient risk. Then Lewis addresses the topic of lower extremity arterial disease and the standard approach of reconstruction for limb salvage. Next, Christman and colleagues present a data-based approach to exercise training and smoking cessation for the treatment of claudication. Bruni follows with a summary of renovascular hypertension, one of the rarer causes of a common problem. She emphasizes the importance of timely diagnosis because renovascular hypertension may have a more serious prognosis than essential hypertension and is less amenable to drug treatment. Furthermore, renovascular hypertension carries a greater risk of progression to accelerated or malignant hypertension, and it may result in irreversible renal failure. Finally, Gylys, editor of the Pharmacology Department, provides a comprehensive overview of low-molecular-weight heparin, a therapeutic advance to the treatment of vascular disease. Stroke, related to carotid artery disease, is not addressed in this issue because a full issue was devoted to this important topic in October 1998 (JCN 13:1).
Patients with vascular disease present with complex nursing problems because of advanced age, associated medical conditions, and the multiple systems affected by atherosclerosis. Because of the significant recent strides in the diagnosis and treatment of vascular disease as well as the increased responsibility of nurses caring for vascular patients, nurses must be conversant with the multifaceted problems of vascular disease if they are to deliver optimal care. This issue is intended to provide a comprehensive reference for nurses caring for vascular patients.
As issue editor, I am grateful for the opportunity to review the subject of vascular disease for you. I also am grateful to the authors who have contributed their expertise to this issue. Recommended Web sites for this issue include the following:
* http://www.processrequest.com/heart/images/dot.gif
* http://www.medscape.com/23206.rhtml
* http://www.medscape.com/23220.rhtml
* http://www.scvir.org/pvd/index.htm
-Victoria A. Fahey, MSN, RN, CVN
Advance Practice Nurse; Vascular Surgery; Northwestern Memorial Hospital; Chicago Illinois
REFERENCES