Peripheral vascular disease

What is peripheral vascular disease?

Peripheral vascular disease refers to any disorder affecting blood flow through the veins and arteries. It most commonly describes a disease affecting the extremities, especially the hands and feet.

Disruption of circulation in the peripheral veins can be caused by venous stasis, overly active blood coagulation (hypercoagulability), or secondarily, as a result of immobility or prolonged inactivity, trauma or serious injury, orthopedic surgery, aging, or dehydration. When venous blood flow is impeded, blood and bacteria may accumulate in the lower extremities, which leads to the formation of leg ulcers.

Decreased venous flow results in increased venous pressure, which promotes varicose veins, possibly leading to inflammation and clotting (thrombophlebitis). Arterial insufficiency in the peripheral vessels is most often due to a build up of fatty deposits (plaque) within the artery (atherosclerosis), blood clots, trauma, spasm of the smooth muscles in artery walls, and structural arterial defects that are present at birth. Interrupted blood flow to the peripheral arteries can lead to inadequate delivery of oxygen to the tissues and, consequently, to tissue death and gangrene.

How is it diagnosed?

History: Arterial insufficiency is characterized by two types of pain.

• The first is a cramping pain brought on by exertion and relieved by rest (intermittent claudication).
• The second type of pain is described as a burning, tingling, or numbness in the affected extremity, which occurs when the individual is at rest, usually lying down.

Physical exam: Assessment includes noting the color and temperature of the skin and signs of developmental changes in the affected area.

Outer layers of skin that are chronically malnourished because of poor blood supply may become shiny, smooth, and thin with little or no hair growth. Nails in the affected limb(s) may appear thick with deposits of corn-like material underneath them. With time, decreased blood supply and, therefore, decreased oxygen levels may produce ischemic changes, causing the skin to assume a purple-black color that is characteristic of cyanosis. These changes may also lead to gangrene.

Assessment of venous circulation focuses on changes in hydration status (edema) and pigmentation of the skin. Chronic edema can lead to ulceration. Venous insufficiency also produces a dark color, dryness, and scaling of the skin in the affected areas (venous stasis dermatitis).

Tests: A number of diagnostic procedures may be ordered to determine the type and cause of the peripheral vascular disease. These may include Doppler ultrasound to identify reduced blood flow to a specific area and locate any obstruction to venous flow, plethysmography to view areas of decreased circulation around the affected area, and phlebography to confirm the diagnosis by showing filling defects and areas of diverted blood flow. Additionally, arteriography may be used to locate lesions and rule out atherosclerosis.

How is peripheral vascular disease treated?

Treatment is aimed at improving blood flow by removing or diminishing the cause(s) of impaired circulation. Buerger-Allen exercises are often prescribed to relieve arterial insufficiency or venous stasis. Individuals are instructed in leg and foot care. The importance of avoiding smoking, keeping warm, and taking prescribed medications, such as anticoagulants or blood thinners, antibiotics, and anti-inflammatory drugs, is also stressed. The specific treatment, however, will vary with the type, cause, and severity of the disease.

Medications

Information	Brand	Generic	Label	Rating
	Plavix	Clopidogrel

Coumadin (Warfarin), Mevacor (Lovastatin), Pravachol (Pravastatin), Zocor (Simvastatin)

What might complicate it?

Complications associated with this condition include atherosclerosis, hypercoagulability, injury, surgery, dehydration, underlying heart, lung, kidney, or liver disease, neurological disorders, ulceration, and gangrene.

Predicted outcome

Overall, with treatment, the prognosis is favorable. The prognosis does vary somewhat depending on the specific type and cause of disease and the stage at which it is first diagnosed.

Alternatives

Differential diagnoses include intermittent claudication, varicose veins, thrombophlebitis, Raynaud's disease, and Buerger's disease.

Appropriate specialists

Cardiovascular surgeon.

Last updated 22 December 2015