Peripheral Vascular Disease

“A circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm.”

• Forms of Peripheral Vascular Disease:
  • Functional PVD (FPVD)
  • Organic PVD (OPVD)

Risk Factors

• Age >50
• Overweight
• High cholesterol
• History Stroke
• Diabetes
• High blood pressure
• Family History

Aetiology

• FPVD – Emotional stress, cold temperatures, operating vibrating machinery or tools, drugs
• OPVD – Smoking, high blood pressure, diabetes, high cholesterol

Pathophysiology

• FPVD – Vessels exaggerate their response (dilation or constriction) to the environment which affects the flow
• OPVD – A change in the structure of the blood vessel (e.g. plaque development due to atherosclerosis) which reduces the flow

Clinical Presentation

• The 6 Ps:
  1. Pallor
  2. Pain
  3. Paraesthesia
  4. Paralysis
  5. Pulselessness
  6. Poikilothermia

• The most common presenting symptoms are claudication, skin changes or wounds that won’t heal

Investigations

• Bloods: n/a
• Imaging:
  • Angiogram
  • Doppler ultrasound flow studies
  • Magnetic resonance angiography (MRA)
• Special:
  • Ankle-brachial index (ABI)
  • Treadmill exercise test
  • Pulse volume waveform analysis

Management

• Conservative:
  • Lifestyle changes
• Medical:
  • Aggressive treatment of existing conditions that may worsen PVD
  • Antiplatelet medication – Aspirin / Clopidogrel
• Surgical:
  • Vascular surgery
  • Angioplasty
    • Balloon angioplasty
    • Atherectomy
    • Laser angioplasty
    • Stent

Complications

• Tissue death (can lead to limb amputation)
• Impotence
• Pale skin
• Pain at rest and with movement severe pain that restricts mobility
• Wounds that don’t heal
• Osteomyelitis