Peripheral Vascular Disease

Peripheral Vascular Disease

Peripheral vascular disease (PVD) is a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm. This can happen in your arteries or veins. PVD typically causes pain and fatigue, often in your legs, and especially during exercise. The pain usually improves with rest.

It can also affect the vessels that supply blood and oxygen to your:

• arms
• stomach and intestines
• kidneys

In PVD, blood vessels become narrowed and blood flow decreases. This can be due to arteriosclerosis, or “hardening of the arteries,” or it can be caused by blood vessel spasms. In arteriosclerosis, plaques build up in a vessel and limit the flow of blood and oxygen to your organs and limbs.

As plaque growth progresses, clots may develop and completely block the artery. This can lead to organ damage and loss of fingers, toes, or limbs, if left untreated. Peripheral Vascular Disease

Peripheral arterial disease (PAD) develops only in the arteries, which carry oxygen-rich blood away from the heart. According to the CDC, approximately 12 to 20 percent of people over age 60 develop PAD, about 8.5 million people in the United States. PAD is the most common form of PVD, so the terms are often used to mean the same condition.

PVD is also known as:

• arteriosclerosis obliterans
• arterial insufficiency of the legs
• claudication
• intermittent claudication

A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except for decreased hair on the right leg. The patient’s popliteal, dorsalis pedis, and posterior tibial pulses were markedly decreased compared with those of his left leg. Peripheral Vascular Disease

Diagnostic Analysis

With the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.

Critical Thinking Questions

1. What was the cause of this patient’s pain and cramping?

2. Why was there decreased hair on the patient’s right leg?

3. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation?

4. What would be the treatment of intermittent Claudication for non-occlusion?

The two main types of PVD are functional and organic PVD.

Functional PVD means there’s no physical damage to your blood vessels’ structure. Instead, your vessels widen and narrow in response other factors like brain signals and temperature changes. The narrowing causes blood flow to decrease.

Organic PVD involves changes in blood vessel structure like inflammation, plaques, and tissue damage. Peripheral Vascular Disease

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Functional PVD

Your vessels naturally widen and narrow in response to your environment. But in functional PVD, your vessels exaggerate their response. Raynaud’s disease, when stress and temperatures affect your blood flow, is an example of functional PVD.

The most common causes of functional PVD are:

• emotional stress
• cold temperatures
• operating vibrating machinery or tools
• drugs

Organic PVD

Organic PVD means there’s change in the structure of your blood vessels. For example, the plaque buildup from arteriosclerosis can cause your blood vessels to narrow. The primary causes of organic PVD are:

• smoking
• high blood pressure
• diabetes
• high cholesterol

Additional causes of organic PVD include extreme injuries, muscles or ligaments with abnormal structures, blood vessel inflammation, and infection.

There are numerous risk factors for PVD.

You’re at higher risk for PVD if you:

• are over age 50
• are overweight
• have abnormal cholesterol
• have a history of cerebrovascular disease or stroke
• have heart disease
• have diabetes
• have a family history of high cholesterol, high blood pressure, or PVD
• have high blood pressure
• have kidney disease on hemodialysis

Lifestyle choices that can increase your risk of developing PVD include:

• not engaging in physical exercise
• poor eating habits
• smoking
• drug use Peripheral Vascular Disease