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Peripheral Vascular Disease (PVD)

Background Knowledge ๐Ÿง 

Overview

  • Refers to circulatory conditions that cause reduced blood flow to the limbs.

  • Often synonymous with peripheral artery disease (PAD), though PAD is specifically arterial, while PVD can involve veins as well.

Aetiology

  • Atherosclerosis is the most common cause.
  • Other causes: Thromboangiitis obliterans (Buerger’s disease), embolic disease, vasculitis.

Risk Factors

  • Smoking
  • Diabetes
  • Hypertension
  • Hyperlipidaemia
  • Age
  • Family history

Clinical Features ๐ŸŒก๏ธ

Symptoms

  • Intermittent claudication: Pain, cramping, or fatigue in leg muscles with exercise that is relieved with rest.
  • Critical limb ischaemia: Pain at rest, non-healing ulcers, or gangrene.

Signs

  • Absent or decreased pulses in affected limb.

  • Pale or bluish skin colour, reduced hair growth, and shiny skin.

Investigations ๐Ÿงช

Investigations

  • Ankle-Brachial Index (ABI): First-line investigation, ratio of ankle systolic pressure to brachial systolic pressure.

  • Duplex ultrasonography: Assess blood flow and structure of leg arteries.

  • Angiography (CT, MR, or conventional).

Management ๐Ÿฅผ

Management

  • First-line: Lifestyle modification (smoking cessation, exercise, optimal diabetes control).

  • Antiplatelet therapy: Aspirin or clopidogrel.

  • Statins for cholesterol control.

  • Interventional: Angioplasty, stenting, bypass grafting in severe disease or non-responders.

Complications

  • Chronic pain
  • Ulcers
  • Gangrene
  • Increased risk of cardiovascular events (stroke, myocardial infarction).
  • Amputation in severe untreated cases.

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Regarding peripheral vascular rest pain:

Analgesia and/or reperfusion procedures may alleviate the pain.

In the recumbent position, gravity cannot aid the blood supply to the legs.

The pain starts by affecting the superficial tissues of the toes and forefoot.

For relief, patients often dangle their legs out of the bed at night, increasing peripheral perfusion.

Only strong analgesics, such as opioid derivatives, relieve the pain.


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