| name: | Peripheral Vascular Disease |
| also known as: | Atherosclerotic Occlusive Disease; Peripheral Arterial Disease; Occlusive Arterial Disease; Arterial Thrombosis; Arterial Embolism; Circulatory Problems; PVD; Claudication; ABI; Ankle-Brachial Index; Ankle Brachial Index; Blood Clot; ICD 444.22 |
| also see: | Claudication; Arterial Embolism; Deep Venous Thrombosis; Superficial Thrombophlebitis; Venous Stasis Disease; Gangrene; Femoral Popliteal Bypass Graft; ICD |
| description: | An arterial thrombosis is a clot that forms in an artery and if it dislodges and travels to a distant site, it is called an arterial embolism. Arterial clot and embolism needs to be distinguished from venous clot and embolism (see Deep Venous Thrombosis). Progressive peripheral vascular disease (PVD) in the leg can lead to absent pulses, loss of blood flow, gangrene of toes, feet, lower leg, and the need for amputation. Aortic PVD, also called aortic aneurysm can lead to rupture. Progressive PVD of the renal arteries can lead to renal artery occlusion and renal atheroembolism with acute renal failure or chronic renal failure. PVD of the fingers is often called Raynaud's and a PVD condition associated with autoimmune disease is called temporal arteritis. Peripheral vascular disease is an impairment of the arterial blood vessel, leading to narrowing, thrombosis formation (clot formation), and subsequent decrease in oxygen and nutrition. Causes of peripheral vascular disease include damage to the internal lining of the artery or the heart, such as atherosclerosis, coronary artery disease, diabetes, injury, heart attack, heart valve disease, atrial flutter or atrial fibrillation). Risk is increased with age, obesity, smoking, stress, high blood pressure, high cholesterol, hyperlipidemia, and diabetes. Peripheral vascular disease generally refers to pathology of the arterial system, and venous stasis disease, pathology of the venous system. |
| signs & symptoms: | Symptoms depend upon what structure or what organ the clot or embolus is cutting off blood flow to. A clot or embolus in the leg (or arm) can cause pain, pain with muscle motion such as claudication (claudication is like angina of the calf muscle), weakness, numbness, tingling, burning sensation, weak or absent pulse in the extremity, skin ulcers, cool skin. Whereas venous stasis disease is associated with thick scaly skin, on the other hand, peripheral vascular disease is associated with thin, shiny skin. The five P's of arterial occlusion are: Pain, Pulselessness (no pulse), Paresthesia (numbness), Pallor, Paralysis. A clot or embolus in the brain can cause temporary visual disturbance, difficulty speaking, paralysis, dizziness, headache, stroke or transient ischemic attack (TIA). A clot or embolus to the intestine can cause abdominal pain, nausea, vomiting, shock (intestinal infarct). |
| diagnosis: | Based on the signs, symptoms, history, and exam, as well as diagnostics studies directed at the suspected location of the clot, and if an arterial embolus, both a work up of the end organ hit by the embolus and the likely source of the traveling clot. Diagnostic studies might include CT Scan, MRI Scan, Doppler ultrasound, and arteriography. An ankle-brachial index (ABI) is a measurement of ankle pressure over arm pressure. An ABI < 0.7 suggests enough PVD consistent with claudication. An ABI < 0.4 suggests significant arterial occlusion that is likely limb-threatening. PVD needs to be distinguished from spinal stenosis which shares some similar symptoms. |
| treatment: | Depends upon the location of the clot and the end organ hit. If the person has an embolus and suffers a stroke, intestinal infarct, kidney infarct, transient ischemic attack, or an ischemic leg or arm, surgical intervention to remove the clot and restore blood flow can be attempted before too much ischemic death has occurred to the tissue. In general, the indications for surgical intervention include cyanosis, pain at rest, neurologic deficit such as numbness and/or paralysis. If the clot has not embolized, treatment can include surgical removal of the clot if possible, plus anticoagulation drugs and antiplatelet drugs including, aspirin and clopidogrel (plavix), and surgery to repair or replace damaged arteries. Other medications used for PVD include nifedipine if vasospasm is a factor, and prednisone if vasculits is a factor. The drug trental helps reduce blood viscosity and might facilitate blood flow past the blockage. Surgery for lower leg revascularization include aorto-iliac bypass graft and femoral popliteal bypass graft or variations thereof. Surgery in the neck include carotid artery endarterectomy. General measures include weight loss, stop smoking, meticulous foot and ankle care, monitored exercise, low salt low fat high fiber diet, cholesterol lowering drugs and other medications directed at underlying risks. |
| prevention: | Treat causes and risks. |
| outcome: | Depends upon where the clot is. Clots in the leg can be treated medically or surgically (rare) preventing complications. Clots in the brain, intestine, kidney often cause damage before they can be treated medically or surgically. Risk of occlusive disease is ischemic tissue, called gangrene. |
skynetMD suggests the following:
| if: | If the person has symptoms suggestive of a clot blocking off blood flow to a part or to an organ, such as pain in the arms or legs, especially with use of the part, extremity weakness, numbness, tingling, burning, decreased or absent distant pulses, or, brain dysfunction, visual disturbance, temporary loss of vision, partial paralysis, headache, or, abdominal pain, drop in blood pressure, increase heart rate |
| go to: | Go to the doctor or the hospital |
| if: | If the person would like a high blood pressure Internet Resource |
| go to: | Go to The American Society of Hypertension www.ash-us.org |
Last updated 4/4/2010