| Peripheral vascular disease (PVD), or peripheral arterial | | | | After physical examination for PVD signs, the following |
| disease (PAD), is a medical term referring to some | | | | tests can be useful: Ankle-Brachial Index (ABI) is |
| vascular diseases affecting the peripheral blood | | | | measured by comparing the blood pressure in the |
| vessels (specifically the arteries). Vascular disease | | | | ankle and the arm. |
| occurs mainly in the legs, but may occur in the | | | | Special Ultrasonography such as Doppler ultrasound |
| stomach or kidney vessels, as well. It is defined by a | | | | and duplex scanning can be useful in assessment of |
| narrowing of the lumen of these arteries that develop | | | | the blood flow and locating any narrowed or blocked |
| cholesterol deposits in the inner wall of the artery. | | | | vessels. |
| These deposits are called atherosclerotic plaques. | | | | Angiography using special contrast materials (dyes) |
| PVD affects both large and small vessels | | | | could be very useful. |
| (macrovascular or microvascular), but the main | | | | Magnetic Resonance Angiography (MRA). |
| presentation is usually due to large vessel involvement. | | | | Computed Tomography Angiography (CTA). |
| The major risk, in this case, is decreasing blood flow | | | | CTA or Catheter angiography is an invasive |
| and tissue perfusion in the tissues supplied by the | | | | procedure, allowing both diagnosis and treatment in the |
| affected artery. | | | | same time. A catheter is inserted and guided through |
| The plaque can rupture, leading to intravascular | | | | an artery in the groin to reach the affected area for |
| thrombosis and embolism. Other than this organic form | | | | visualization, and at the same time allowing widening by |
| of the disease, there is a functional form occurring with | | | | angioplasty techniques, or applying medications in the |
| no structural changes in the arteries, but there is an | | | | affected area, to enhance the blood flow. |
| intermittent spasm (severe constriction) in the arteries | | | | Treat PVD Early |
| leading to ischemia (lowered tissue oxygenation, | | | | Treatment of PVD requires proper diagnosis and |
| nutrition and increased waste products accumulation in | | | | management of the causes, risk factors, |
| the tissue due to decreased blood supply). | | | | manifestations and complications, if present. |
| This functional form usually leads to short-term attacks, | | | | Medications should be given to control diabetes, |
| and may occur in many forms. An example of this | | | | hypertension, hypercholesterolemia and dyslipidemia. |
| form is Raynaud's disease, where the spasm is | | | | Anti-coagulants and peripheral vasodilators are useful |
| triggered by cold temperature, smoking or emotional | | | | in improving the blood flow. |
| stress.Although PVD has a very diverse etiology and | | | | In some cases, angioplasty or surgery may be required |
| the mechanism is not clear, PVD is known to be | | | | to improve the blood flow. In angioplasty a small |
| common with diabetes as a major risk factor, | | | | catheter is inserted in the artery and a small balloon at |
| especially if associated with smoking. | | | | its tip is inflated to reopen the artery. Sometimes a |
| Smoking and Risk FactorsSmoking is an aggravating | | | | stent insertion (small mesh framework) into the vessel |
| risk factor. The metabolic changes made by these | | | | is required to keep it open and prevent future |
| two factors in the blood, such as hypertension, | | | | blockage. |
| dyslipidemia and hypercholesterolemia, are the leading | | | | Alternatively, PVD can be treated by bypass surgery, |
| causes of atherosclerosis, coronary artery disease | | | | utilizing a graft bypass using a vessel taken from |
| and PVD. Other risk factors are family history of PVD, | | | | another part of the body. Doctors also recommend |
| old age, high levels of homocysteine and C-reactive | | | | following a supervised exercise program to improve |
| protein CRP in the blood.In mild cases, PVD may | | | | the blood flow and to increase the limb capacity, in |
| remain asymptomatic. | | | | order to walk and function with less leg cramps and |
| However, it is a progressive disease and with time, the | | | | complications. |
| narrowing will be more severe and persistent, leading | | | | Finally, strict, preventive measures should be taken. |
| to serious manifestations. A patient with PVD is | | | | Simple lifestyle modifications can make a difference. |
| typically presented with 5 Ps in his affected limb | | | | Stop smoking, control diabetes, lower blood cholesterol, |
| (Pulselessness, Parasthesia ("numbness"), Pallor, Pain | | | | control hypertension, start eating healthy foods and |
| "intermittent claudication or cramping" and even | | | | perform mild, regular exercise as recommended by |
| Paralysis). Other symptoms may be vascular ulcers | | | | your primary care provider. Mild, regular exercise is |
| ("Painful leg sores showing no healing with time"), hair | | | | proven to be the best measure you can take, in order |
| loss in the affected leg, changes in its toenail and | | | | to control diabetes, atherosclerosis and cardiovascular |
| recurrent infections with delayed healing. | | | | disorders. |
| Patients with PVD have a risk for, what is called, | | | | Patients should also mind proper foot care to avoid |
| critical limb ischemia (CLI), in which the blood supply is | | | | developing vascular ulcers and infections. Regular foot |
| not enough to maintain vital tissues, leading to their | | | | cleansing and the use of skin moisturizers are |
| death and putrefaction (gangrene). Also having | | | | important to maintain healthy feet. |
| advanced atherosclerosis complicated by PVD means | | | | Injuries that may lead to infections should be avoided. |
| that the patient is also at risk for developing other | | | | Also, wearing well fitting shoes with thick protective |
| atherosclerotic complications such as heart failure, | | | | socks will prevent foot trauma and infection, which can |
| coronary artery disease and stroke. | | | | be dangerous in a patient with PVD. Patients should be |
| Diagnose Peripheral Vascular Disease | | | | instructed to take care during trimming nails, avoid |
| Diagnosis of PVD requires proper physical examination | | | | walking barefoot and advise their primary care doctor, |
| and laboratory tests with good differential diagnosis. | | | | in case of any trauma, sores or infections. |