PERIPHERAL VASCULAR DISEASE-PVDDr jignesh vora

OVERVIEW

PVD refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain.

Also kn as peripheral arterial disease, PAD a condition that develops when the arteries

that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis.

ATHEROSCLEROSIS is a gradual process whereby hard cholesterol substances

(plaques) are deposited in the walls of the arteries. Cholesterol plaques cause hardening of the artery walls and

narrowing of the inner channel (lumen) of the artery. The atherosclerosis process begins early in life atherosclerosis becomes advanced with aging, it can cause

critical narrowing of the arteries resulting in tissue ischemia (lack of blood and oxygen).

atherosclerosis of the coronary arteries can lead to angina & heart attacks.

Advanced atherosclerosis of the carotid and cerebral arteries (arteries that supply blood to the brain) can lead to strokes and TIAs

Advanced atherosclerosis in the lower extremities can lead to pain while walking or exercising (claudication), deficient wound healing, and/or leg ulcers

ATHEROSCLEROSIS CAUSES

1) atherosclerosis can limit the ability of the narrowed arteries to increase delivery of blood and oxygen to tissues during periods of increased oxygen demand such as during exertion

2) complete obstruction of an artery by a thrombus or embolus resulting in tissue necrosis (death of tissue

WHAT ARE COLLATERALS?

Sometimes, despite the presence of a severe blockage in an artery, the involved area does not become painful or ischemic due to the presence of collateral vessels.

Collateral circulation means that the particular area is supplied by more than one artery to an extent that blockage of a single vessel does not result in a severe degree of ischemia.

Collateral circulation can develop over time to help provide oxygenated blood to an area where an artery is narrowed.

Doctors believe that regular supervised exercise can stimulate the growth and development of collateral circulation and relieve symptoms of intermittent claudication.

COMPLICATIONS

open sores that do not heal ulcers gangrene infections amputation

OTHER CAUSES

 vasculitis connective tissue diseases such as lupus blood-clotting disorders damage to blood vessels during surgery can

also lead to tissue ischemia.  Raynaud's disease, which is believed to

occur due to spasms in blood vessels brought on by stress, tobacco smoking, or a cold environment.

WHO R VULNERABLE

High blood levels of the bad LDL cholesterol and triglycerides

DM HTN Low blood levels of the good HDL cholesterol Cigarette smoking family history Chronic renal failure obesity Physical inactivity

SYMPTOMS

intermittent claudication . Rest pain  Numbness of the extremities Weakness and atrophy of the calf muscle A feeling of coldness in the legs or feet Changes in color of the feet Hair loss over the dorsum of the feet and

thickening of the toenails Painful ulcers and/or gangrene

DX

Colour doppler USG Angiography CT MRI

RX

Smoking cessation . healthy diet  Rx for diabetes, lipid levels, and blood

pressure . Supervised exercise

MEDICATION

Antiplatlet drug - aspirin, clopidogrel Anticlotting drugs – warfarin Rx for HTN, DM, lipids

SX

Angioplasty Sx – bypass surgery