PERIPHERAL
VASCULAR
DISEASE
Valerie Robinson D.O.
Peripheral Vascular Disease AKA
Peripheral Artery Disease
• AKA Arteriosclerosis Obliterans
• Caused by atherosclerosis
• Arterial walls lose compliance
• Is usually progressive
• May occlude medium and large arteries
• Vascular disease may manifest acutely when
thrombi, emboli, or acute trauma compromises
perfusion.
• Risk factors
• Dyslipidemia
• Diabetes
• CAD
• HTN
• Renal failure
• Smoking
• Hx of CVA or MI
Symptoms
• Most commonly found in the lower extremities
• Claudication – worse when walking fast, uphill, or for a long
distance
• Aortoiliac disease manifests as pain in the thigh and buttock, whereas
femoral-popliteal disease manifests as pain in the calf
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Slow healing
Poor circulation (pale, cool feet)
Raynaud’s phenomenon
Ulcers and/or Gangrene
Neuropathy
Night-time leg cramps
Pain gets better when leg is hanging
Leriche syndrome is a clinical syndrome described by
intermittent claudication, impotence, and significantly
decreased or absent femoral pulses.
Diagnosis: Physical Exam
• Peripheral signs of peripheral vascular disease are the classic
"5 P's":
• Pulselessness
• Paralysis
• Paraesthesia
• Pain
• Pallor
• Ankle-brachial index
• Bruits
• Loss of hair on legs and feet, skin becomes pale and shiny
• Atrophied muscles, especially calf
• Ulcers
• Cyanosis/paleness
Diagnosis: Tests
• Ankle-Brachial Index (ABI)
• BPankle/BPbiceps
• If <0.9, mild PAD.
• Between 0.5 and 0.9 is moderate dz with claudication
• If <0.5, severe PAD often has gangrene or ulcers
• Doppler
• Angiography, MRA, or CTA
• Before and after stent
Treatment
• Increase exercise, but allow time for rest
• Control risk factors such as smoking, HTN, lipids, DM
• Anti-platelet drugs: aspirin, Plavix (clopidogrel)
• Phosphodiesterase inhibitors: Trental (pentoxifylline),
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Pletal (cilostazol)
Statins
Amputation, ABI<0.3
Angioplasty with stents
Bypass
References
• “Peripheral artery disease – legs.” A.D.A.M. Medical
Encyclopedia. PubMed Health. U.S. National Library of
Medicine.
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001223/.
Updated May 14, 2012
• “Doppler assessment and ABPI: Interpretation in the
management of leg ulceration.” World Wide Wounds.
http://www.worldwidewounds.com/2001/march/Vowden/D
oppler-assessment-and-ABPI.html
• Stephens, Everett MD. “Peripheral Vascular Disease.”
Medscape.
http://emedicine.medscape.com/article/761556overview#showall Updated March 15 2010.