Peripheral Vascular Disease

Peripheral Vascular Disease

Peripheral vascular disease (PVD), commonly referred to as peripheral arterial disease (PAD) or peripheral artery occlusive disease (PAOD), refers to the obstruction of large a

rteries not within the coronary, aortic vasculature, or brain. i.e. disease of the major arteries of the limbs.

Peripheral arterial disease includes:

1.     Acute arterial occlusion

2.     Chronic arterial occlusion

3.     Aneurysms

Acute arterial occlusion:

Sudden occlusion of an artery is caused by:

1.     Embolism

2.     Thrombosis of an atheromatous plague

3.     Arterial trauma

Embolic arterial occlusion:

An embolus is a body that is foreign to the bloodstream (although its constituents may be part of blood) and which may become lodged in a vessel and cause obstruction.

An embolus is most commonly a thrombus (blood clot), but it can be a foreign body, parasitic ova, air bubble, amniotic fluid …etc. The heart is the most common source of embolization usually due to ischemic heart disease.

Emboli may lodge in any organ and cause ischaemic symptoms.

Clinical features:

Depending on the site of arterial occlusion:

Limbs: (6P) pain, pallor, paresis, purchasing cold, pulselessness and paraesthesia.

Brain: stroke

Intestine: gangrene of corresponding loop of bowel

Spleen: splenic infarction and left hypochondrial pain

Kidney: loin pain and hematuria

The leg is often affected. The limb is cold and the toes cannot be moved. Pulse is usually absent distal to the site of obstruction and examination of the pulse may give an idea of the site of embolic occlusion. The pulse proximal to the obstruction may be forceful (stronger than the contralateral normal side).

Diagnosis:

The diagnosis is usually made clinically in a patient who has no history of claudication and has a source of emboli, who suddenly develops severe pain or numbness of the limb, which becomes cold and pale or even mottled. Once the diagnosis is made no time should be lost in waiting for investigations.

Confirming investigations include:

1-    Doppler

2-    Duplex ultrasound

3-    Peripheral angiography

4-    CT angiography or MRA

Treatment:

1-    Immediate administration of 5000 U of heparin intravenously (80-150 U/kg body weight) can reduce the extension of the propagating thrombosis and maintain patency of the surrounding vessels.

2-    Relieve pain

3-    Emergency embolectomy under local or general anesthesia (using a Fogarty balloon catheter).