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DISEASE
Specificity of Activity
Treadmill walking is the recommended
exercise.
Stop Smoking
On average, smokers are diagnosed with
PVD as much as 10 years earlier than non-
smokers.
Stopping smoking now is the single most
important thing you can do to halt the
progression of PVD or prevent it in the future.
Medications
Drugs that lower cholesterol or control high
blood pressure.
Decrease blood viscosity.
Trental, Persantine, or Coumadin
Antiplatlet agents: their primary long-term
benefit is reduction in cardiovascular events
and mortality.
ASA doses of 75 to 325mg QD have shown
protective benefits.
Ticlid and Plavix also have shown promise
in disease prevention and in therapy after
vascular intervention.
Interventional Radiology
Treatments
Angioplasty
Stents
Thrombolytic Therapy
Stent-Grafts
Gene-Based Therapy
The field of molecular genetics has provided
new understanding of vascular physiology and
pathology and has opened exciting frontiers in
the treatment of PVD.
Direct gene transfer by intramuscular injection
of DNA encoded with vascular growth factors
has resulted in growth of new vessels and
collateral circulation in chronically occluded
lower extremity arterial vessels.
Surgical Treatments for PVD
Thrombectomy
Bypass Grafts
Aneurysms
Most common lethal peripheral vascular
abnormality.
An artery whose diameter is 1.5 times the
normal.
Aortic aneurysms are caused by weakening of
the artery walls due to atherosclerosis. The
weakened walls balloon out, forming an
aneurysm.
When blood pumps from the heart through the
aorta, it places pressure on the aneurysm
walls. Over time, the aneurysm can get bigger
and bigger, until eventually it may rupture.
Aortoiliac Occlusive Disease
Typically involves the distal abdominal aorta
as well as the common and external iliac
arteries.
Aortobifemoral bypass with a prosthetic graft
has been the traditional treatment of choice
for aortoiliac occlusive disease since the
1960s.
The operative morbidity and mortality are in
the 2% range, and long-term patency
exceeds 90%.
Superficial Femoral Occlusive
Disease
Presents with symptoms of claudication of the
calf and sole of the foot.
Usually improves as collateral circulation
develops.
Best treatment initially is antiplatelet therapy
in combination with a vigorous exercise
program.
Tibial Artery Disease
Distal atherosclerotic disease involving the
tibioperoneal trunk and the tibial vessels is
the most difficult to treat and leads to the
greatest morbidity and tissue loss.
ABI is typically less than 0.4 before rest pain
develops, and any value less than 0.3 almost
always results in ischemic tissue loss.
Upper Extremity Disease
Atherosclerotic disease involving the arms is
almost always limited to the larger proximal
vessels and rarely involves the brachial,
radial, or ulnar arteries.
Although these patients have no symptoms,
they can have a large discrepancy in BP
between the left and right arms.
Always prudent to measure BP in both
arms.
Thrombosis
A thrombus, or blood clot, within a blood
vessel.
Normally, a blood clot forms to prevent
bleeding but a thrombus is an abnormal blood
clot in the vessel when it is not even
punctured.
The clotting process may be encouraged by
the buildup of fatty acids on the vessel walls.
Thrombosis in the vein may cause pain and
swelling.
Deep Venous Thrombosis
A blood clot in a deep vein.
May form on the valves within the vein, and
may subsequently increase in size to totally
occlude the vein.
Sometimes parts of the clot may break off and
travel in the bloodstream to the lungs and
cause serious health problems (pulmonary
embolism).
DVT is perhaps the most dangerous problem.
Patients with DVT have a 30 to 40% risk of
recurrence later in life.
Phlebitis
Inflammation of the leg veins.
Two types:
Inflammation of the veins on the surface of
the leg (more common).
Inflammation of the deep veins of the leg.
Phlebitis is caused by an infection or injury.
Can cause a blood clot to form and this clot
can then embolize and result in pulmonary
embolism. This is the worst thing that can
happen if you have phlebitis.
Pulmonary Embolism
An embolus is a clot or any other piece of
material that is carried around in the blood.
Pulmonary embolism is where the embolus
gets stuck in a vessel going to the lungs.
The only way a clot can go to a vessel in the
lungs is if it passes through the heart and is
pumped out of the pulmonary artery.
So, the closer the clot is to the heart, the
more likely to get a pulmonary embolism.
Varicose Veins
Caused because either the blood flow is too slow
making the vein pile up with blood or the valve in
the vein is not working well so the blood falls
down due to gravity and piles up in the veins of
the legs.
Sclerotherapy: Irritant chemical is injected into
the veins, causing them to scar and seal off. This
detours the blood to nearby healthier veins.
Stripping: Procedure used to remove larger
varicose veins. Parts of the vein can be removed
or tied off, or the entire vein can be removed.
Surgery continues to play an important role in
the management of peripheral vascular
disease.
Revascularization procedures provide
excellent outcomes for many patients at risk
for loss of a limb or seriously impaired quality
of life.
Although endovascular techniques are now
being used for managing many vascular
problems, the traditional surgical approaches
still offer well-documented benefits.