PERIPHERAL VASCULAR DISEASEValerie 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

• 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),

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/Doppler-assessment-and-ABPI.html

• Stephens, Everett MD. “Peripheral Vascular Disease.” Medscape. http://emedicine.medscape.com/article/761556-overview#showall Updated March 15 2010.