Peripheral Vascular Disease

Question 1

What is peripheral Vascular Disease? What does it often affect?

Answer 1

Peripheral vascular disease refers to when any one of the arteries (apart from the ones supplying the heart and the brain) like ones in the legs, arms, or other organs becomes narrowed, which reduces blood flow; this often affects the limbs.

Question 2

What type of vessels are usually involved in peripheral vascular disease? What is it also called?

Answer 2

Peripheral vascular disease, or PVD, usually involves the arteries, so sometimes it’s also referred to as peripheral artery disease or PAD

Question 3

What are organic PVDs? Causes of Organic PVDs?

Answer 3

PVD is usually caused by a blockage, called organic PVD.

Organic PVD is most commonly created by atherosclerosis.

However, the vessel could be blocked by an embolus,

Question 4

Explain atherosclerotic PVD.

Answer 4

Atherosclerosis is a buildup of lipids and fibrous material just under the inner lining of the blood vessel, called the tunica intima.

When plaque builds up, it narrows the artery, which reduces perfusion to whatever tissue it tends to supply; this buildup usually happens over the course of many years.

Question 5

Explain Embolic PVD.

Answer 5

The vessel could be blocked by an embolus, which can happen suddenly if a blood clot from some upstream artery lodges in a peripheral artery; this clot would obviously stop blood flow from getting to the tissue the vessel supplies.

Question 6

What are the types of PVDs?

Answer 6

Organic PVD and functional PVD.

Question 7

What is functional PVD? Examples of functional PVD?

Answer 7

With functional PVDs, blood vessels stop blood flow by changing diameter, such as with vasospasms, where the vessel constricts and blood flow is reduced.

This type of PVD is usually short term, and can come and go.

Question 8

Which arteries are mostly affected in PAD?

What is the result of PAD of these arteries?

What Molecule is released as a result? What is this molecule?

What results from the release of this molecule? What is this called?

Answer 8

The arteries supplying the legs are the most commonly affected vessels in peripheral vascular disease.

When less blood gets to the muscle tissue in the legs, the tissue receives less oxygen and becomes ischemic.

Ischemic cells release adenosine, a type of signaling molecule, which is thought to affect nerves in these areas; this is felt as pain.

This pain in the legs is often referred to as claudication.

Question 9

The pain caused in the lower limbs due to PVD is called what?

What is the reason for this pain?

Answer 9

Claudication.

Due to the release of adenosine by the ischemic cells, which affect the nerves in the area.

Question 10

When is PAD patients more symptomatic, and when are they less symptomatic? Explain.

What is the main symptom Of PAD?

Answer 10

Sometimes, even though blood flow is narrowed with PVD, when a person is at rest, there’s enough of blood to meet the tissue’s demands; thus, people are often asymptomatic during rest.

However, if the person is walking or exercising, then the leg muscles start to work harder and demand more oxygen; demand becomes greater than what’s supplied, which causes the claudication, or pain.

Question 11

What is the diagnostic importance of claudication in PAD?

Answer 11

The location of the pain is a clue to which artery is involved.

Question 12

What artery (or arteries) is most likely affected by PAD if pain is felt in the hips and the buttocks?

Answer 12

If the pain is in the hips and the buttocks, think of lower aorta or iliac.

Question 13

Which artery (or arteries) are likely affected by PAD if pain is in the thigh?

Answer 13

If the pain is in the thigh, think of the iliac or common femoral artery.

Question 14

Which artery (or arteries) are likely affected by PAD if pain is in the upper 2/3 of the calf?

Answer 14

For the upper 2/3 of the calf, think of the superficial femoral artery;

Question 15

Which artery (or arteries) are likely affected by PAD if pain is in the upper 1/3 of the calf?

Answer 15

for the lower ⅓ of the calf, think of the popliteal artery.

Question 16

Which artery (or arteries) are likely affected by PAD if pain is on the foot?

Answer 16

For the foot, think of the tibial or peroneal artery.

Question 17

Symptoms of PAD

Mild and serious complications.

Answer 17

Apart from claudication,

leg or foot wounds, or ulcers, that don’t heal up normally

color changes of focal areas of the skin Eg if the leg’s been affected, the foot might turn pale white when it’s raised (called elevation pallor). Likewise, the foot might turn red when it’s lowered, which is called dependent rubor, because gravity is working with the blood flow in this direction.

As the arterial blockage gets bigger, less and less blood gets to the tissues, which can lead to more serious complications.

1. “rest pain” describes a continuous burning or pain in the forefoot and toes when the legs are elevated; this pain is relieved when the limbs are lowered, such as by hanging the feet over the bed or walking around the room, because doing so allows more blood to get down to the foot.
2. If the blockage is severe enough, the limb might be at risk of gangrene, or death of the tissue, because if deprived of oxygen for long enough, the cells can actually die, or necrose. If this happens, the dead tissue would likely have to be removed, and in some cases, the limb would have to be amputated.

Question 18

What are the risk factors and causes of PVD?

Answer 18

The major risk factors and causes of peripheral vascular disease are the same as those for atherosclerosis because they are similar process.

Smoking seems to be the biggest contributor to PVD

Other diseases and conditions that are also linked to a higher risk of PVD include: diabetes; dyslipidemia, or an abnormal amount of lipids in the blood; being older than 60 years, metabolic syndrome and hypertension.

Question 19

Diagnosis of PAD.

Answer 19

Diagnosing PVD usually involves listening to the pulse in the iliac arteries of the legs with a stethoscope.

1. A whooshing sound can be heard on auscultation, called a bruit. This is due to narrowing of the artery.
2. Another test that can be done is a doppler ultrasound, which is a noninvasive way of visualizing blood flow.
3. The most common test to diagnose PVD is the ankle-brachial index (ABI), where blood pressure is taken in the ankle and in the arm, and then compared. PVD is typically diagnosed if the systolic blood pressure in the ankle divided by the systolic blood pressure in the arm is less than 0.9.

Question 20

What clinical symptoms are seen at different ranges of ABI in the diagnosis of PVD?

Answer 20

In general, claudication is often seen in people with an ABI between 0.4 and 0.9.

Rest pain is likely present if an ABI is between 0.2 and 0.4.

Tissue loss, ulcers, and gangrene are likely if an ABI is between 0 to 0.4.

Question 21

What 3 methods can be implemented for the treatment of PVDs?

Answer 21

Treating PVD often requires significant lifestyle changes that address the underlying risk factors, such as quitting smoking, adopting healthy eating habits, and exercising regularly.

Sometimes in addition to these changes, people with PVD will also get certain medications that aim to reduce the likelihood of blood clotting and obstruction of the blood vessels.

Surgical intervention, like angioplasty or bypass surgery, is rarely needed.

Question 22

What 3 methods can be implemented for the treatment of PVDs?

Answer 22

Treating PVD often requires significant lifestyle changes that address the underlying risk factors, such as quitting smoking, adopting healthy eating habits, and exercising regularly.

Sometimes in addition to these changes, people with PVD will also get certain medications that aim to reduce the likelihood of blood clotting and obstruction of the blood vessels.

Surgical intervention, like angioplasty or bypass surgery, is rarely needed.

Question 23

When does PVD become symptomatic? Why?

Answer 23

most people with peripheral vascular disease actually don’t have symptoms until occlusion becomes significant, which is when 70% of the vessel lumen is obstructed.

This is because the blood supply may be enough to meet the muscle needs at rest, but not the increased needs during activity, leading to ischemia – so basically, occurs when oxygen demand is greater than oxygen supply.