PERIPHERAL VASCULAR DISEASE
summary : Peripheral vascular disease (PVD) is a condition, in which a build-up of fatty deposits in the arteries which reduces the inner diameter of the vessel and restricts blood supply. It's also known as Peripheral arterial disease (PAD).
Peripheral vascular disease is a manifestation of systemic atherosclerosis that leads to significant narrowing of arteries distal to the arch of the aorta. The most common symptom of peripheral vascular disease is intermittent claudication. At other times, peripheral vascular disease leads to acute or critical limb ischemia. Intermittent claudication manifests as pain in the muscles of the legs with exercise; it is experienced by 2 percent of persons older than 65 years.
In one study of out-patients in the United States, PVD was present in 29 percent of patients.2 This study included patients older than 70 and patients 50 to 69 years of age with a history of cigarette smoking or diabetes mellitus.
Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult. The standard office-based test to determine the presence of peripheral vascular disease is calculation of the ankle-brachial index. Magnetic resonance / CT arteriography, duplex scanning, and hemodynamic localization are noninvasive methods for lesion localization and may be helpful when symptoms or findings do not correlate with the ankle-brachial index. Contrast arteriography/ DSA is used for definitive localization before intervention.
Treatment is divided into lifestyle, medical, Interventional and surgical therapies.
Lifestyle therapies focus on exercise, smoking cessation, and dietary modification. The greatest modifiable risk factor for the development and progression of PVD is cigarette smoking.
Medical therapy is directed at reducing platelet aggregation.
In addition, patients with contributing disorders such as hypertension, diabetes, and hyperlipidemia need to have these conditions managed as aggressively as possible. Interventional Radiology therapies includes stents, arterectomies, angioplasty, and Surgical therapies include bypass surgery endarterectomy.