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Peripheral Vascular Disease

Definition

(Show Disclaimer) Note: I copy the "definition" of something straight from the book. I find it's best to have an all-encompassing definition in order to better orient myself when I am studying.

Show Definition Peripheral vascular disease (PVD) is a general term that encompasses all occlusive or inflammatory diseases that occur within the peripheral arteries, veins, and lymphatics. These conditions include peripheral arterial disease (PAD), deep vein thrombosis (DVT), superficial thrombophlebitis, lymphoedema, and chronic venous diseases. Chronic venous diseases include chronic venous insufficiency (CVI) and varicose veins.

Incidence/Prevalance

  1. Chronic venous insufficiency, more common in women than men.
  2. Varicose veins may/may not have a difference between men and women.

Pathogenesis

Predisposing factors

  1. Age, female gender, immobilization, hx of DVT, stature (tall people), obesity, sedentary lifestyle.
  2. PMH of CAD, HTN, diabetes, HLD.

Common Findings

  1. CVI:
    1. Extremity edema.
    2. Pain worse when standing, usually dull, aching, or cramping.
    3. Pain improved with elevation.
    4. Itching sensation.
    5. Feeling of heaviness in extremity.
    6. Hyperpigmentation.
    7. Thickening and hardening of the skin.
    8. Ulcerations.
  2. Varicose veins: blue vein prominent, burning/aching/itching, leg fatigue,

    symptoms worse at the end of the day

    .

Other Signs and Symptoms

Be sure to exclude limb ischemia with the six Ps:
Pain, Pallor, Poikilothermia, Parasthesias, Pulselessness, Paralysis.

Complications

  1. CVI:
    1. Cellulitis.
    2. Peripheral neuropathy.
    3. Varicose veins.
    4. Abscess.
    5. Ulceration.
    6. Stasis dermatitis.
    7. DVT.
  2. Varicose veins:
    1. Stasis dermatitis.
    2. Stasis ulceration.
    3. Petechial haemorrhage.
    4. Chronic oedema.
    5. Superficial thrombophlebitis.
    6. Hyperpigmentation.

History

  1. HPI: quality - crushing/stabbing/burning
  2. ROS:
  3. ALL/MEDS/HIITS: (What are HIITS? - Click to expand)

    make sure to ask about surgical history.

  4. PMH/FAMHx/OBGYN:
  5. SOCHx:

Physical Exam

Coming soon.

Diagnostic Tests

Trendelenbug test, Ankle-brachial index (ABI), duplex ultrasound, venography.

Look for LVH, old MI, and arrythmia on ECG.

DDx

Infection, arthritis, peripheral neuropathy, nerve root compression, DVT.

Plan

  1. General:
    1. Rest
    2. Compression socks
    3. Elevation
    4. Exercise
    5. Smoking cessation
  2. Medical/Surgical:
    1. Diuretics
    2. Antibiotics if chronic
    3. ASA probably stimulates healing.
    4. Phlebectomy/Venous ablation

Follow-up

Not important, move on with your life.

Consultation/Referral

Hospitalization if limb ischemia. Wound care if skin ulceration. Podiatrist for foot care, shoe fitting.

Individual Considerations

Consider prolonged immoblization as a sign of lethargy and therefore depression in geriatric populations.

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