Peripheral Vascular Disease

Question 1

What is the pathophysiological cause of peripheral vascular disease?

Answer 1

Atherosclerosis disease of large/medium arteries

Question 2

What is the normal state of blood flow and pressure in healthy person?

Answer 2

Resting blood flow to extremity muscle groups of ~ 300-400mm/min

Blood flow may increase 10-fold on exercise

BP at ankle usually greater than BP at arm

Question 3

Describe the pathophysiology of early stage of peripheral vascular disease?

Answer 3

Resting blood flow normal/ slightly reduced

Blood flow can’t increase enough on exertion due to arterial stenosis => Claudication occurs

BP at ankle not as high as in healthy person due to stenoses reducing pressure, more marked difference when exercising

Question 4

Describe the pathophysiology of late stage of peripheral vascular disease?

Answer 4

Resting blood flow may also be reduced, ischaemic changes occur, e.g. ulcers

Question 5

Risk factors same as for IHD, CVA etc.

Answer 5

Smoking
Diabetes
Hypertension
Hyperlipidaemia
Family history
Sedentary lifestyle

Question 6

Name the symptoms of PVD?

Answer 6

Claudication

Livedo Reticularis

Arterial ulcers & poor healing wounds

Question 7

Name the signs of PVD?

Answer 7

The 5 Ps

Pulselessness
Paralysis
Paraesthesia
Pain
Pallor

Question 8

What is livedo reticularis?

Answer 8

Lace-like purplish discolouration of the lower extremities

Caused by stagnation of blood in capillaries/small vessels etc.

May progress to cyanosis

Question 9

What needs to be done to investigate peripheral vascular disease?

Answer 9

Ankle-Brachial Index

Doppler pulse studies

Arterial duplex scanning

MR/CT Angioography

Question 10

What is the treatment for PVD?

Answer 10

Lifestyle - Smoking cessation, walking, treat underlying conditions

Medical - antiplatelets, statins

Surgical - balloon dilatation, stenting, bypass