Peripheral Vascular Disease commonly called Peripheral Arterial
Disease refers to obstruction of large arteries except those supplying
the heart, head ,neck or brain.The basic abnormality is either a
narrowing of the peripheral arteries as a result of any inflammatory
process involving the vessels or there is a mechanical obstruction to
the flow of blood distal to the site of obstruction. This may include
Atherosclerosis,a condition in which an arterial wall thickens due to
accumulations of fatty materials such as cholesterol, or it may be
blockage of the artery by a blood clot called a thrombus or an embolus
which is any intravascular mass detached from its origin and is capable
of blocking an artery at a distant site.
Peripheral vascular disease is a term used commonly for the
atherosclerotic blockage of arteries found in the lower extremities.
There are a series of symptoms ,progressive as the disease advances
leading to a disabling condition that is amputations usually if not
intervened at a proper time. It starts as a mild pain while walking
known as claudication caused by incomplete blood vessel obstruction.
This stage leads to a more severe pain while walking at a relatively
shorter distance known as intermittent claudication. This is followed by
pain even at rest which increases when the limb is raised. The worst
and rather irreversible stage is the stage of biological tissue loss and
gangrene. Other associated symptoms are sores, wounds and ulcers of the
affected area that are usually poor in healing or do not heal at all.
Some noticeable colour changes means the affected part turns pale and
colder than the the normal part and diminshed hair and nail growth can
be noticed .
The risk factors include
1. Smoking, the single most important modifiable cause of peripheral
vascular disease internationally. Smokers have a ten fold increase in
relative risk for the disease.
2. Diabetes mellitis causes 2-4 times increase risk of the disease.
This group acounts for approximately upto 70% of the non traumatic
amputations performed . A known diabetic who smokes increases his risk
of getting the vascular insufficiency.
3. Dyslipidemias including eleveted cholesterol levels, high bad
cholesterols known as LDL, low good cholesterols, HDL, elevated
triglyceride levels are also co related with PVD(peripheral vascular
disease)
4. High blood pressures is associated with increased risk of PVD as well as with heart attacks and strokes.
Some of the tests the doctor may rely to diagnose are
1. Physical examination: might reveal signs such as weak or absent
pulses in the affected limb, whooshing sounds known as bruits can be
heard with a stethescope, evidence of poor wound healing and decreased
blood pressure in the affected limb
2. Ankle Brachial Preesure Index:it is a common test to diagnose PVD.
It compares the blood pressure in the ankle to the blood pressure in
the arm.If the blood pressure reading in the ankle is lower than that in
the arm, blockage of the arteries providing blood from the heart to
distal lower limb is suspected.
3. Ultrasound: Special ultrasound imaging techniques, such as doppler
ultrasound helps to look for site and extent of blockage or narrowing
of arteries.
4. Angiography:modern diagnostic imaging techniques such as magnetic
resonance angiography (MRA) or computed tomography angiography(CTA)
allows the imaging of the arterial system following the injection of a
dye in the blood vessels. Some more invasive procedures for example
catheter angiography allows diagnosis as well as treatment at the same
time which involves passage of a catheter from an artery in the groin of
the patient to the affected narrowed part of the artery and widening
that part with angioplasty procedure or injecting some medicine to
improve the blood flow in that part
5. Blood tests: for diabetes and cholesterol levels
The treatment aims at
a. Relieving symptoms such as leg pain etc
b. To stop the progression of atherosclerosis throughout the body to
reduce risk of heart attacks and stroke. The first step in achieving
these goals is to change one’s lifestyle. Quiting smoking is the
single most important thing to reduce the risk of complications.
Mangement of diabetes, management of high blood cholesterol levels and
high blood pressures all contribute to reduce the rate of disease
progression and to avoid the complications. If medical treatment alone
is insufficient surgical intervention may be required in the form of
angioplasty or bypass surgery. Moreover supervised exercise programs can
help to increase he distance a patient can walk pain free.
Critical limb ischemia is a serious complication that begins as open
sores that dont heal, an injury or an infection of the feet or legs and
they progress to tissue death and gangrene sometimes requiring
amputations of the affected limb.Heart attack an stroke are other
complications if the fat deposits also build in arteries supplying the
heart and brain respectively.
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