Peripheral Vascular Disease

Gould, Rodriguez, Keiser, Sherman, Adkins, Heiledge

Pathogenesis of PVD

Peripheral Vascular Disease (PVD) is an inflammatory disease of the peripheral arteries. It is primarily caused by atherosclerosis, also known as hardening of the arteries which narrows them. It can also be because of a thrombus or embolus in the lower extremities. These thrombi come together and result in the obliteration of arteries in the extremities. This causes decreased blood flow to the extremities and that causes pain and tenderness. The pain results from an imbalance between supply and demand of blood flow that fails to satisfy metabolic demands.

Risk Factors

Traditional Risk Factors:

-Smoking

-Hypertension

-Male gender or women after menopause

-Diabetes

-Over age 65

-Family History

-Increased Low Density Lipoproteins

-Decreased High Density Lipoproteins


Non-Traditional Risk Factors

-Inflammation markers

-Highly-sensitive C-reactive protein (hs-CRP)

-Increased serum fibrinogen

-Insulin resistance

-Infection

-Periodontal disease

Diagnostic

Early diagnosis of PVD is crucial in successful treatment. It can prevent life-threatening complications. It is important that the patient tell health professional any symptoms so that PVD testing can begin as soon as possible. There are several tests to diagnose PVD:


-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.

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Treatment of PVD

There are two goals in treating PVD. The first is to manage the symptoms and pain for the patient and the second is to stop the spread of atherosclerosis and obstruction of blood flow in the arteries and veins in order to reduce the risk of heart attack and stroke. If lifestyle changes such as stopping smoking isn't enough, then medications become necessary.


  • 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.

Clinical Manifestations

For a doctor looking at a patient who is believed to have peripheral vascular disease, he/she would look for symptoms such as:

  • 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.

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