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Peripheral vascular disease

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.
Etiology
  • 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 Presentation
  • Intermittent claudication: Pain, cramping, or fatigue in leg muscles with exercise that’s relieved with rest.
  • Critical limb ischaemia: Rest pain, non-healing ulcers, or gangrene.
  • Absent or decreased pulses in affected limb.
  • Pale or bluish skin colour, reduced hair growth, and shiny skin.
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
  • First-line: lifestyle modification (smoking cessation, exercise, optimal diabetes control).
  • Antiplatelet therapy: e.g., 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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