By the end of this chapter the student will be able to:
Classify peripheral vascular disease into peripheral arterial disease and peripheral venous disease.
Identify the signs and symptoms of peripheral arterial diseases.
Discuss risk factors, causes, and pathogenesis of peripheral vascular diseases.
Explain the role of different diagnostic modalities in the diagnosis of diseases of peripheral vessels.
Identify the signs and symptoms of peripheral venous diseases.
Decide on the best treatment modality for arterial and venous disorders of peripheral vessels.
Explain the clinical presentation, diagnosis, and treatment of diseases of the aorta.
Apply the above knowledge in a clinical setting.
Diseases of the peripheral vessels include a spectrum of disorders involving the arteries, veins, and lymphatics. Peripheral arterial disease is the most common entity among all of these. A systematic and comprehensive approach is required to diagnose and treat the vascular disorders. They are the major cause of morbidity rather than mortality unlike other cardiovascular disorders. Advancements in the medical, interventional, and surgical management of vascular disorders have made a tremendous improvement in the quality of life of the affected population.
Peripheral Arterial Disease
Peripheral arterial disease (PAD) is narrowing (ie, stenosis) of the peripheral arteries that compromises the blood supply to the limbs. It affects more than 10% of the population above the age of 60 years, and the number continues to grow with the aging population.
The PARTNERS (Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival) program defines PAD using the Ankle-Brachial Index (ABI) of <0.9 and reports PAD prevalence of 29% in high-risk individuals (age older than 70 years without additional risk factors, or age 50 to 69 years with a history of cigarette smoking or diabetes) seen in primary care clinics in the United States.
Atherosclerosis is the leading cause of PAD in 90% of patients. The development of fat-rich atheroma in the vessel wall reduces its lumen and thereby impairs the distal blood flow. Atheromas usually occur at arterial bifurcation. Other less common causes (10%) include vascular inflammation, entrapment, and trauma (see Table 16.1).
Table 16.1Causes of peripheral arterial disease |Favorite Table|Download (.pdf) Table 16.1 Causes of peripheral arterial disease
|Causes of PAD |
|1. Atherosclerosis (90%) |
|2. Buerger disease |
|3. Arterial compression by bone/tendon (thoracic outlet syndrome, entrapment syndromes) |
|4. Trauma |
Clinical Presentation: Signs and Symptoms
Patient history and symptoms of PAD include pain in an affected limb on exertion (intermittent claudication), or pain confined to an affected hand or foot but not the entire limb at rest (critical limb ischemia), or pain in an entire limb at rest (ischemic neuropathy) which can be associated with the loss of sensation and function that can progress to blackening of the digits (gangrene) if it is not treated. The pain syndrome should be addressed in detail with proper recording of onset, progression, intensity (in terms of grade 1-10), characteristics, and aggravating and relieving factors ...