Peripheral vascular disease

Key words: Peripheral arterial disease, PVD, atherosclerosis

Peripheral vascular disease is chronic, peripheral manifestation of atherosclerosis, which may affect the lower limbs, cerebral vessels, or mesenteric/renal vasculature.

First Consult provides a detailed medical topic on diagnosing and treating peripheral vascular disease. Some key points include:

• The ankle-brachial index is a very powerful tool for initial diagnosis, as peripheral vascular disease is often silent
• Co-existant coronary artery disease is very common in patients with peripheral vascular disease
• Medical management of peripheral vascular disease includes aspirin (or clopidogrel), exercise, cholesterol lowering, smoking cessation and good blood sugar control to prevent micro-vascular disease
• Revasularization is important for severe symptoms or critical ischemia

Guidelines and clinical resources

• ACC/AHA 2005 Practice Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric...)
• Atherosclerosis journal - the official journal of the European Atherosclerosis Society, affiliated with the International Atherosclerosis Society and the Society of Atherosclerosis Imaging and Prevention.
• Emedicine article on atherosclerosis
• AIHW statistics on Peripheral vascular disease in Australia
• NSW Cancer Institute handout on Peripheral vascular disease and smoking [235KB]
• National Heart Foundation of Australia physical activity recommendations for people with cardiovascular disease. Evidence-based recommendations on physical activity for people with cardiovascular conditions, including peripheral vascular disease.
• SIGN's Diagnosis and management of peripheral arterial disease: a national clinical guideline. Recommendations on the management of lower limb peripheral vascular disease. Guidelines cover modification of cardiovascular risk, symptom management and prevention of progression and complications.
• NICE guidelines on Clopidogrel and modified-release dipyridamole in the prevention of occlusive vascular events. Clopidogrel is recommended to be used in the prevention of occlusive vascular events in people who are intolerant of low-dose aspirin and either have experienced an occlusive vascular event or have symptomatic peripheral arterial disease.

Images

Patient with peripheral vascular disease. Gadolinium-enhanced three-dimensional MR angiogram (MRA)... From Bowker & Pfiefer: Levin and O'Neal's The Diabetic Foot.

Unusual causes of peripheral vascular disease. A, Fibromuscular dysplasia of both external iliac... From Valji: Vascular and Interventional Radiology.

Upper extremity peripheral vascular disease. Posteroanterior (A) and lateral (B) radiographs of a... From Weissman: Imaging of Arthritis and Metabolic Bone Disease