dr jignesh vora

1. PERIPHERAL VASCULAR DISEASE-
PVD
Dr jignesh vora

2. OVERVIEW
 PVD refers to diseases of the blood vessels
(arteries and veins) located outside the heart and
brain.
 Also kn as peripheral arterial disease, PAD
 a condition that develops when the arteries that
supply blood to the internal organs, arms, and legs
become completely or partially blocked as a result
of atherosclerosis.

3. ATHEROSCLEROSIS
 is a gradual process whereby hard cholesterol substances
(plaques) are deposited in the walls of the arteries.
 Cholesterol plaques cause hardening of the artery walls and
narrowing of the inner channel (lumen) of the artery.
 The atherosclerosis process begins early in life
 atherosclerosis becomes advanced with aging, it can cause
critical narrowing of the arteries resulting in tissue ischemia
(lack of blood and oxygen).
 atherosclerosis of the coronary arteries can lead to angina &
heart attacks.
 Advanced atherosclerosis of the carotid and cerebral arteries
(arteries that supply blood to the brain) can lead
to strokes and TIAs
 Advanced atherosclerosis in the lower extremities can lead to
pain while walking or exercising (claudication), deficient
wound healing, and/or leg ulcers

4. ATHEROSCLEROSIS CAUSES
1) atherosclerosis can
limit the ability of the
narrowed arteries to
increase delivery of
blood and oxygen to
tissues during periods
of increased oxygen
demand such as during
exertion
2) complete obstruction
of an artery by a
thrombus or embolus
resulting in tissue
necrosis (death of
tissue

5. WHAT ARE COLLATERALS?
 Sometimes, despite the presence of a severe blockage
in an artery, the involved area does not become painful
or ischemic due to the presence of collateral vessels.
 Collateral circulation means that the particular area is
supplied by more than one artery to an extent that
blockage of a single vessel does not result in a severe
degree of ischemia.
 Collateral circulation can develop over time to help
provide oxygenated blood to an area where an artery is
narrowed.
 Doctors believe that regular supervised exercise can
stimulate the growth and development of collateral
circulation and relieve symptoms of intermittent
claudication.

6. COMPLICATIONS
 open sores that do not heal ulcers
 gangrene
 infections
 amputation

7. OTHER CAUSES
 vasculitis
 connective tissue diseases such as lupus
 blood-clotting disorders
 damage to blood vessels during surgery can also
lead to tissue ischemia.
 Raynaud's disease, which is believed to occur due
to spasms in blood vessels brought on by
stress, tobacco smoking, or a cold environment.

8. WHO R VULNERABLE
 High blood levels of the bad LDL cholesterol
and triglycerides
 DM
 HTN
 Low blood levels of the good HDL cholesterol
 Cigarette smoking
 family history
 Chronic renal failure
 obesity
 Physical inactivity

9. SYMPTOMS
 intermittent claudication .
 Rest pain
 Numbness of the extremities
 Weakness and atrophy of the calf muscle
 A feeling of coldness in the legs or feet
 Changes in color of the feet
 Hair loss over the dorsum of the feet and thickening
of the toenails
 Painful ulcers and/or gangrene

10. DX
 Colour doppler USG
 Angiography
 CT
 MRI

11. RX
 Smoking cessation .
 healthy diet
 Rx for diabetes, lipid levels, and blood
pressure .
 Supervised exercise

12. MEDICATION
 Antiplatlet drug - aspirin, clopidogrel
 Anticlotting drugs – warfarin
 Rx for HTN, DM, lipids

13. SX
 Angioplasty
 Sx – bypass surgery