Peripheral Vascular Disease (PVD) or Peripheral Arterial Disease (PAD)

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | Patient Advice

Definition

Peripheral Vascular Disease (PVD), commonly referred to as Peripheral Arterial Disease (PAD), is a condition characterised by narrowing or blockage of the arteries, typically in the legs, leading to reduced blood flow. See Figure 1.

Aetiology

The primary cause of PVD is atherosclerosis (plaque buildup in the arteries). Contributing factors include:

• Smoking: Damages the arterial walls and accelerates plaque formation.
• Diabetes: Increases the risk of vascular complications.
• High Cholesterol: Promotes plaque formation in arteries.
• Hypertension: Causes stress on arterial walls.
• Obesity: Adds to the workload of the circulatory system.

Pathophysiology

PVD arises due to the following mechanisms:

• Atherosclerosis: Fatty deposits (plaque) accumulate in arterial walls, reducing blood flow.
• Ischaemia: Insufficient oxygen delivery to tissues, leading to pain and tissue damage.
• Inflammation: Chronic low-level inflammation contributes to plaque instability and thrombosis.

Risk Factors

Common risk factors include:

• Smoking.
• Diabetes.
• High cholesterol and LDL levels.
• Hypertension (high blood pressure).
• Family history of cardiovascular disease.
• Ageing (common in individuals over 50).

Signs and Symptoms

Symptoms of PVD include:

• Intermittent Claudication: Cramping pain in the legs, typically triggered by walking and relieved by rest.
• Rest Pain: Severe pain in the feet or toes, usually at night.
• Non-healing Wounds: Ulcers on the legs or feet that fail to heal due to poor circulation.
• Coldness in the Affected Limb: Indicates reduced blood flow.
• Pale or Discoloured Skin: Due to reduced oxygen delivery.

Investigations

Key investigations include:

• Ankle-Brachial Index (ABI): A simple test comparing blood pressure in the arms and legs. An ABI < 0.9 suggests PVD.
• Doppler Ultrasound: Non-invasive imaging to assess blood flow and locate blockages.
• Blood Tests:
  • Lipid Profile: To identify elevated cholesterol levels.
  • Glucose Levels: To detect diabetes or pre-diabetes.
• CT Angiography or MR Angiography: Advanced imaging to visualise arterial narrowing or blockages.
• Pulse Examination: Reduced or absent pulses in the affected limb indicate significant arterial narrowing.

Management

1. Lifestyle Modifications

• Smoking Cessation: Essential to slow disease progression.
• Exercise Programme: Regular walking to improve blood flow and reduce symptoms of claudication.
• Dietary Changes: Low-fat, high-fibre diet to manage cholesterol and blood sugar levels.

2. Medical Management

• Antiplatelet Therapy: Aspirin or clopidogrel to reduce the risk of clot formation.
• Lipid-lowering Therapy: Statins (e.g., atorvastatin) to reduce cholesterol levels.
• Antihypertensives: Medications to manage blood pressure effectively.

3. Interventional Procedures

• Angioplasty: Balloon dilation to open narrowed arteries, sometimes with stent placement.
• Bypass Surgery: Creating a graft to reroute blood flow around the blocked artery.
• Amputation: Reserved for severe cases with gangrene or infection.

4. Specialist Referral

Referral to a vascular specialist is required for persistent symptoms or severe cases, particularly when interventional procedures are being considered.

Patient Advice

Key advice includes:

• Quit smoking to slow disease progression.
• Adopt a healthy diet to control cholesterol and blood sugar levels.
• Engage in regular, supervised exercise to improve circulation.
• Attend regular follow-ups to monitor the condition and adjust treatment if needed.

Figure 1

Image illustrating normal and narrowed arteries in Peripheral Arterial Disease.

References

1. Jmarchn (2014). Peripheral Arterial Disease [Image]. Available at: https://upload.wikimedia.org/wikipedia/commons/7/70/Blausen_Peripheral_Arterial_Disease_eng.svg (Accessed: 30 December 2024).