Peripheral Vascular Disease(PVD): Causes, Signs & Symptoms, Diagnosis &Treatment

peripheral vascular disease or pvd is a condition involving blood vessels other than the ones which supply the brain in the heart like legs arms or any other organ pvd mainly involves arteries so sometimes it is called as peripheral arterial disease or pad major cause of peripheral vascular disease is atherosclerosis other causes include thromboembolism inflammatory conditions like berger's disease and functional conditions like raynaud's phenomenon in addition diabetes mellitus hypertension smoking and old age may be some risk factors for the development of pvd now let's discuss about some clinical manifestations of peripheral vascular disease pvd mainly involves the arteries of legs narrowing of the arterial lumen causes ischemia to the tissues supplied by the particular artery this will result in a condition called intermittent claudication where the pain is felt during exertion and resolves with resting in addition reduced blood supply may cause diminished or absent pulse when palpated area of the skin supplied by the occluded artery becomes dry and shiny along with hair loss nails become thick and brittle it is important to keep in mind that unlike in venous obstruction which is characterized by buildup of edematous fluid there is no edema in arterial obstruction other symptoms of peripheral vascular disease include painful regularly shaped round ulcers that do not heal up normally dependent ruber which is characterized by redness distal to the affected artery when placed under gravity this is due to the dilation of small arteries to allow more blood to the distal area however these vessels lose their ability to constrict and ultimately cause redness another feature of pvd is elevation power this feature can be seen when the affected area is elevated against the gravity since the vessel is already constricted blood has a hard time to get to the affected area against gravity results in power complete obstruction of an artery may cause gangrene of the affected area and the iliac artery claudication will result in impotence in males now let's discuss a bit about berger's disease and raynaud's phenomenon berger's disease is an inflammatory condition of blood vessels it mainly involves medium and small sized arteries like tibial and radial artery however sometimes it can affect the entire neurovascular bundle including the nerve artery and vein cigarette smoke is strongly associated with berger's disease and it affects males of 20 to 40 years of age commonly affects lower limbs but can affect the upper limbs as well in berger's disease there is segmental inflammation of the arteries which causes narrowing of the lumen and ultimately thrombosis and complete obstruction of the affected artery this will give rise to certain clinical features of arterial obstruction segmental inflammation of the vessels is thought to be due to hypersensitivity and autoimmune reactions which cause direct injury to the endothelium and antibody mediated destruction of the endothelial cells and there is a genetic base as well clinical manifestations of berger's disease are due to arterial obstruction and neural involvement of the affected area features of arterial obstruction include skin ulceration intermittent claudication and gangrene of digits features of neural involvement include severe leg pain even at rest cold sensitivity and numbness and tingling of the toes and fingers brain odds phenomenon is a functional cause of peripheral vascular disease it is characterized by episodes of vasospasm of the digital arteries and arterioles of fingers and toes vasospasms cause reduced blood flow to the areas supplied by those arteries raynaud's phenomenon is triggered when the person is exposed to intense cold or when the person is in a stressful situation this will cause exaggeration of sympathetic activity and initiate vasoconstriction of arteries which results in initial power and persistent vasoconstriction will cause dilation of venules and accumulation of deoxygenated blood which will cause cyanosis with re-warming of the area vasospasms get relieved and the arteries become dilated this will increase the blood flow to the affected area which is known as reactive hyperemia due to reactive hyperemia the area starts to look red in color not only the fingers and toes in some people tip of the nose earlobes and lips are also affected by raynaud's there are two types of raynaud's phenomenon primary ray nods and secondary raynaud's primary type is more common in young women and it is an exaggerated response to cold and stress this will resolve with rewarming or with relieving stress persistent vasospasms however can cause atrophy of the skin and subcutaneous tissue and rarely ulceration secondary type occurs due to an underlying arterial disease like berger's disease sle and scleroderma and it is usually more severe than the primary type persistent vasospasms may cause ischemic ulcers gangrene and auto amputation of the digits diagnosis of peripheral vascular disease is mainly clinical if you suspect pvd look for the signs and symptoms we discussed above in addition you may hear bruits on auscultation of the affected artery a bruit is an abnormal sound generated by the turbulent blood flow if not enough you can perform a doppler ultrasound test which is a non-invasive method of visualizing the blood flow treatment of peripheral vascular disease includes significant lifestyle changes like quitting smoking dietary modifications and regular exercises some people are given medications to reduce the risk factors these include anticoagulants like aspirin to reduce the likelihood of thrombosis lipid lowering drugs like adervastatin to control hypercholesterolemia anti-diabetics and anti-hypertensive drugs and rarely in some cases surgical intervention is required these include angioplasty and bypass surgeries okay now let's quickly make a summary of what we have discussed today peripheral vascular disease mainly involves the arteries of legs and arms and the major cause of pvd is atherosclerosis other causes include thromboembolism inflammatory conditions like berger's disease and functional causes like raynaud's phenomenon risk factors for pvd include smoking diabetes mellitus hypertension and old age signs and symptoms of pvd we discussed above include intermittent claudication diminished or absent pulse round painful ulcers dependent ruber elevation pallor and other minor ones diagnosis of pvd is mainly clinical in addition you may hear bruits on auscultation and doppler ultrasound to visualize the blood flow treatment include lifestyle modifications like quitting smoking dietary modifications and regular exercises medications like anticoagulants lipid lowering drugs anti-diabetics and anti-hypertensive drugs rarely you may need surgery like angioplasty and bypass all right that's all i wish to discuss in this video thanks for watching stay tuned for more videos you