Peripheral vascular disease

Medicine > Cardiovascular

Background Knowledge 🧠

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 🌡️

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 🧪

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 🥼

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.

Key points

Peripheral vascular disease is a chronic progressive disease most commonly caused by atherosclerosis.
Important risk factors include: smoking, diabetes and increasing age.
Ankle-Brachial Index is the first line investigation of choice.
Effective prevention and management is important to reduce the risk of cardiovascular events.

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