Peripheral Vascular Disease
Gould, Rodriguez, Keiser, Sherman, Adkins, Heiledge
Pathogenesis of PVD
-Male gender or women after menopause
-Over age 65
-Increased Low Density Lipoproteins
-Decreased High Density Lipoproteins
Non-Traditional Risk Factors
-Highly-sensitive C-reactive protein (hs-CRP)
-Increased serum fibrinogen
-Measuring the pulses in patients legs and feet- Bruits indicate a narrowed area in the vessel.
-Doppler ultrasound- This test shows the blood flow in the patients vessels.
-Ankle-Brachial Index- This is most common. A blood pressure cuff and ultrasound assess blood pressure and flow. Brachial and ankle blood pressure is taken and compared.
-Pulse volume recording- Checks blood flow in legs. A blood pressure cuff is placed on the patients arm and leg at the same time and a device assess their blood flow.
-Angiography- A catheter is guided through an artery in the patients groin. It is passed to the targeted area. Contrast dye is injected and an x-ray can identify a clogged artery.
-Magnetic resonance angiography- This a noninvasive imaging technique that allows doctors to view blood flow and diagnose blockages.
Treatment of PVD
- Medication to lower cholesterol- This lowers additional risk factors such as heart attack and stroke by helping get rid of the "bad" cholesterol LDL but maintaining HDL.
- Medication to lower blood pressure- Control systolic blood pressure.
- Medication to control blood sugar- This is key especially if you are diabetic to keep the sugar in your blood lower.
- Medication to prevent blood clots- Plavix or aspirin can help lower your risk of blood clots by thining out your blood so that it is easier for blood to reach your extremities.
- Medication for symptom relief- Plitol can vasodilate vessels to increase blood flow and allow for a larger range for blood to flow, especially if it is thicker or if the walls of the vessel are thicker with plaque and helps with the acutal claudication and pain associated with it. Trenal has the same effects but the effects are generally experienced on a lower scale.
In some cases surgery may become a necesssary option, especially if intermittent claudication is present. Angioplasty is a procedure where a catheter is threaded through a blood vessel to the affected artery. The ballon is inflated to flatten the blockage in the vessel wall and it stretches the wall. Bypass surgery is another option that uses a vessel from another part of your body creating a "synthetic fabric" so this allows blood flow around blocked or narrowed artery. Thrombolytic therapy injects a clot-dissolving drug into your artery at the point of the clot to break it up.
- Painful cramping in hip, thigh, or calf muscles after activity, like walking or climbing stairs
- Leg numbness of weakness
- Coldness in lower leg or foot
- Sores on toes, feet, or legs that won't heal
- Change in color of legs
- Hair loss or slower hair growth on feet and legs
- Slower growth of toenails
- Shiny skin on legs
- No pulse or weak pulse in legs or feet
- Erectile dysfunction in men
Complications that can occur due to peripheral vascular disease include: critical limb ischemia is where open sore do not heal on the legs or feet. This also includes injuries or infection of the affecting limb. It occurs when injuries of infections continue to progress and can lead to amputation. Peripheral vascular disease can also lead to a stroke or a heart attack due to the build up of deposits in arteries that supply blood to the heart and brain.
- Bell, D. (2013). Peripheral Arterial Disease Overview. Podiatry Management, 32(1), 175-182 8p.
- Peripheral artery disease (PAD). (n.d.). Retrieved December 5, 2015, from http://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/basics/symptoms/con-20028731
- Shrikhande, Gautam V,McKinsey, James.Diabetes and peripheral vascular disease: Diagnosis and management. New York: Springer.