Peripheral Vascular Disease

Introduction

Peripheral Vascular Disease, otherwise known as claudication, intermittent claudication, arteriosclerosis obliterans or arterial insufficiency of the legs, is a circulatory system disorder that results in either spasms blockage, or narrowing of the vasculature located outside central organs like the brain and the heart.  This paper, therefore, critically highlights PVD, with a particular focus on the disease process, signs and symptoms, diagnostic techniques, collaborative management as well as the prognosis (Alonso, McManus, & Fisher, 2011).

Overview

PVD can affect both veins and arteries leading to fatigue and pain in extremities especially the legs and during exercises. Although severe during exercise PVD-associated pain usually abates with rest. Other areas affected by PVD include the stomach and the intestines, the arms as well as the kidneys. The narrowing, spasm or blockage associated with PVD results in a decrease in perfusion to the affected part. Another common cause of PVD is the hardening of the arteries or arteriosclerosis, where plaques develop along the arterial walls thereby minimizing blood flow and oxygenation of vital organs as well as the limbs. If untreated, the plaque may progress forming clots that may completely block the arteries leading to permanent damage and loss of peripheral organs like the toes, fingers or limbs. Peripheral Arterial Disease PAD, which is the most common form of PVD, affects only the arteries impeding the flow of oxygen-rich blood from the heart to other organs (Alonso, McManus, & Fisher, 2011). 

Classification

Organic and functional PVD are the two major types of the disease, where the former involves changes in the structure of the vasculature like tissue damage, inflammation as well as the formation of plaques. Functional PVD, on the other hand, involves narrowing or widening of the vasculature in response to other factors other than the physical damage of vascular structure. Such factors may include temperature changes as well as brain signals. The subsequent narrowing interferes with blood supply to various organs in the body. Other common conditions that co-exist with PVD include atrial fibrillation, cerebrovascular disease, renal disease and coronary artery diseas (Ikem, Adebayo, & Soyoye, 2010).

Causes

The causes of PVD are varied, but at the same time type specific, while it is common for the blood vessels to either narrow or widens depending on the environment, this function is highly exaggerated in the functional form.  To this end, the effect of temperature and stress on the blood flow as well as Raynaud’s disease can be classified under this type of PVD. However, among the most common causes of functional PVD are; cold temperatures, emotional stress, drugs as well as the operation of heavy machinery with a high rate of vibrations. Organic PVD, on the other hand, is the alteration of the structure of the vessel and may be as a result of arteriosclerosis plaques. Nevertheless, the primary causes of this type of PVD include high blood pressure, smoking, high cholesterol levels as well as smoking. Besides, severe tissue injuries, inflammation of the vasculature, muscular or ligament abnormalities and infection can also exacerbate organic PVD (Alonso, McManus, & Fisher, 2011).

Risk Factors

The advanced age of over 50 years, abnormal cholesterol, overweight, history of stroke or cerebrovascular disease, diabetes, and heart diseases are some of the risk factors for PVD. Other risk factors include; a family history of high blood pressure, PVD or high cholesterol together with patients with kidney disease and on hemodialysis.  Poor lifestyle choices like inactivity, poor feeding habits drug use and smoking may increase chances of PVD development (Ikem, Adebayo, & Soyoye, 2010). 

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Signs and Symptoms

Most often than not, develops slowly and assumes an irregular pattern. The most common sign of PVD is cramping, fatigue and discomfort in the lower limbs that worsen with physical activity as a result of interrupted blood flow with the pain disappearing during rest. Muscles may also feel heavy or numb, the toes turn color, and this may be accompanied by thick opaque toenails that are blue in color. The legs may have little or hair growth with regular cramps, especially when lying in bed. The legs and arms may also turn pale or reddish blue even as the legs and feet experience chronic wounds, and chronic ulcers that are difficult to heal, the skin on the feet and the legs also become pale and thin. The commonest symptom in PAD and PVD is claudication which refers to the pain experienced in the muscles of the lower limb especially when walking. Utmost care should be taken to pick the symptoms earlier in the disease process as it is likely to brush aside the symptoms as a normal aging process. Delayed treatment and diagnosis remain a fertile ground for complications like excessive blood loss, the formation of dead or gangrene tissue. Equally, the acute form of the disease is characterized by the sudden development a pale, cold and painful limb with no or weak pulses and sensation and is treated as a medical emergency.  Other complications include impotence and blood stream and bone infections that are life-threatening (Alonso, McManus, & Fisher, 2011). 

Diagnostic Techniques

With early diagnosis, PVD can successfully be treated and associated complications prevented. To this end, more concise tests in the diagnosis of PVD includes Doppler ultrasound, ankle-brachial index (ABI), angiography to include magnetic resonance angiography (MRA) as well as computerized tomography angiography (CTA). All these diagnostic techniques are useful in detecting blockage in the muscles and form the basis for appropriate medical attention (Walker & Hiramoto, 2012). 

Lifestyle Changes

Treatment of PVD is aimed at slowing or stopping disease progression thereby minimizing chances of complications and also helps relieve the pain associated with claudication especially on exertion. Because poor lifestyle features as one of the risk factors for PVD, the first line of management is targeted at modification of lifestyle. In lifestyle change, it is imperative to develop and incorporate a comprehensive exercise schedule and include it in the activities of daily living (ADL), embark on eating a balanced diet while at the same time cutting on weight. As part of lifestyle modification, one should cease smoking as it impairs circulation in peripheral tissues worsening PVD and increasing the risk of heart stroke as well as heart attack. Foods high in saturated fats and cholesterol should also be avoided at every cost as this may increase chances of developing PVD (Shrikhande & McKinsey, 2012). 

Specific Medications

As far as chemotherapy is concerned, pentoxifylline or cilostazol may be used in claudication cases to enhance blood flow and minimize pain. To break down blood clots, aspirin or daily clopidogrel is effective. Because high cholesterol levels are also associated with PVD, statins like simvastatin and atorvastatin are beneficial. High blood pressure in PAD, is managed by angiotensin-converting enzyme inhibitors may also be used and last, but not least, in patients who already have diabetes, proper management of the disease with the appropriate diabetes medication is imperative in managing blood sugars. Surgical intervention is highly recommended in cases of arterial blockages that are severe. In such situations, vascular surgery or angioplasty is the treatment of choice. A stent may also be inserted into the blocked arteries to maintain patency. Vein grafting, a form of vascular surgery, is meant to enhance perfusion past the occluded section by allowing blood bypass (Ikem, Adebayo, & Soyoye, 2010). 

Prognosis

With early diagnosis and treatment, the prognosis in PAD is good. However, it is imperative to note that, the mortality rate is still high as a result of the associated or the underlying co-morbid conditions like the coronary artery and the cerebrovascular disease. In a nutshell, Peripheral Artery Disease, (PAD) is among the leading causes of bleakness and mortality in the USA. Not exclusively is it a noteworthy reason for amputations and immobility, yet it is likewise unequivocally connected with an expanded danger of death, stroke, and myocardial infarction.  Studies reveal a high rate of PAD in ladies. However, this is not perceived by the general population or by clinicians. One potential explanation behind this is women with PAD are more probable than men to be asymptomatic or have atypical side effects. Also, ladies with PAD encounter higher rates of practical decay and may have poorer results after surgical treatment for PAD contrasted to men. The role of gender in determining the onset, progression, and surgical outcomes of PAD is still poorly understood (Alonso, McManus, & Fisher, 2011).