peripheral vascular disease

Question 1

what is PVD

Answer 1

Peripheral vascular disease (PAD) is a chronic progressive atherosclerotic disease leading to partial or total peripheral vascular occlusion

Question 2

what is the etiology of PVD

Answer 2

primarily driven by progressive atherosclerotic disease resulting in the reduction of major organ blood flow and end-organ ischemia.

Question 3

what are the risk factors associated with the progressive atherosclerotic disease

Answer 3

Tobacco use
Diabetes mellitus
Hypertension
HIV
High cholesterol
Age more than 50 years
Elevated homocysteine levels
BMI greater than 30
Family history of cardiovascular disease

Question 4

what is the epidemiology

Answer 4

• 20% over 80 have the disease

Question 5

patho of VAD

Answer 5

• primarily driven by the progression of atherosclerotic disease
• Atherosclerosis begins with lipoprotein accumulation within the intimal layer of large arteries
• The lipoprotein presence within the endothelium leads to lipid oxidation and cytokine response with the infiltration of lymphocytes and macrophages
• Macrophages consume these oxidized lipids and form foam cells leading to the development of “fatty streaks.”
• these can develop into more advanced plaques
• Atherosclerotic plaque builds up slowly over decades within the wall of the vessel. Plaque accumulation results in vascular stenosis and frequent vascular dilation.
• Once the vessel dilation capacity is maximized, the plaque continues to accumulate, which further compromises the lumen occasionally, leading to critical narrowing of the artery
• this leads to ischemia claudication, pain from lack of blood flow.

Question 6

What are the different types of ischemia

Answer 6

• most severe is critical limb ischemia, limb pain at rest or impending limb loss
• acute ischemia - ensue if in-situ vascular thrombosis occurs or a cardioembolic source suddenly occludes the narrowed vessel
  intermittent claudication (classic) - exercise-induced cramping sensation with associated fatigue, weakness, and or pressure.

Question 7

Signs and symptoms of PAD

Answer 7

• over 50% of patients are asymptomatic
• main symptom is claudication resulting in muscle pain , cramping, commonly felt in the calf
• coldness in the leg or foot
• no pulse or week pulse in legs or feet
• shiny skin on legs
• skin colour changes

Question 8

treatment and managment of PVD

Answer 8

• cardiovascular risk factor modification
• exercise therapy
• pharmacotherapy (cilostazol and naftidrofuryl)