Peripheral vascular disease (PAD) involves reduced blood flow and oxygen through peripheral vessels, potentially leading to ischemia and necrosis. Key risk factors include age, smoking, hypertension, and diabetes, with symptoms differing between arterial and venous diseases. Assessment methods include Doppler ultrasonography and the ankle-brachial index, while treatment options range from lifestyle changes to surgical interventions.

1. PERIPHERAL VASCULAR DISEASE

2. PERIPHERAL VASCULAR DISEASES
• Reduction in blood flow & hence oxygen through
the peripheral vessels.
• When the need of tissues for oxygen exceeds the
supply, ischemia and necrosis will develop.

3. PERIPHERAL VASCULAR DISEASES
ARTERIAL DISEASES VENOUS DISEASES
• Atherosclerosis of aorta and
its branches –
(atheroma/plaque causing
stenosis)
• Varicose veins – dilated,
elongated, tortuous.
• Deep vein thrombosis –
Thrombosis in deep vein off
legs.
• Thrombophlebitis- varicose
veins becoming thrombosed
and inflamed

4. RISK FACTORS
• Age – blood vessels become less elastic with age.
• Sex - M>F
• Smoking – nicotine causes vasoconstriction and spasm
of arteries.
- reduces O2 transport to tissues.
• Hypertension – causes elastic tissues in arteries to be
replaced by fibrotic tissues.
• Hyperlipidemia and obesity – accelerates plaque
formation due to more lipid.
• DM – abnomal fat and glucose metabolism.
• Emotional stress - activates SNS – high BP.
• Family history of atherosclerosis.

5. CHARACTERSTICS
Arterial Disease Venous Disease
Skin Cool, hairless, dry ,
shiny, pallor, rubor on
dangling.
Warm, thickened,
mottled, pigmented areas
Pain Sharp, stabbing, worsens
with activity, lowering
feet may relieve pain.
Aching, cramping,
activity and walking may
sometimes help, elevating
relieves pain
Ulcers Severly painful, pale,
grey base, found on heel,
toes, dorsum of foot.
Moderately painful, pink
base, mostly medial
aspect of ankle.
Pulse Absent or diminished Usually present
Edema infrequent Frequent esp at end off
the day and in areas of
ulceratiom.

6. DIFFERENTIAL DIAGNOSIS
• Osteoarthritis.
• Neuropahy.
• Sciatica.
• Myopathy.
• Spinal stenosis.

7. ASSESSMENT
• Investigations – Doppler ultrasonography,
- computed tomographic angiography,
- magnetic resonance angiography,
- Arteriography.
• Ankle Brachial Index.
Noncompressible > 1.4
Normal ABI 1.00 – 1.3O
Borderline(equivocal) 0.91 – 0.99
Mild to moderate 0.41 – 0.90
Severe impairment <0.40

8. Claudication
• Intermmitent claudication –
major symptom of PAD .
• Reproducible aching, cramping
sensation or fatigue - affecting
muscles of calf – 1/both legs.
• Triggered with weight bearing,
relieved by rest.
• Rest Pain – As severity of
occlusion increases – pain when
lying in bed, relieved by hanging
leg bedside.
• Rest pain is indicative of
deterioration may lead to
gangrene if vascular
reconstruction not done.

9. EXERCISE TESTING
• Standardized treadmill protocols.
Claudication pain –
1 – no pain.
2 – onset of pain.
3 - mild pain.
4 - moderate pain.
5 – Severe pain.
• 6MWT if treadmill testing not possible.
• Balance test.
• Contraindications –
 Unstable angina.
Decompensated heart failure.
Uncontrolled cardiac arrhythmias.
Severe or symptomatic valvular heart disease
Critical limb ischaemia.

10. OTHER CONSIDERATIONS
• Most patients with PAD have co existing CAD.

11. EDUCATION & PRECAUTIONS
• Tobacco caessation.
• Nutrition – same as CAD
• Stress reduction.
WHEN DIABETES IS PRESENT –
Usually co existing neuropathy.
• Self eamination of distal foot
• Shock absorbing shoes , not tight.
• Avoid tight clothing.
• Regular glucose checkups.
• Lifelong exercise

13. NON
SURGICAL

15. SURGICAL CONSIDERATIONS
Surgeries commonly performed –
• Sympathectomy
• Endarterectomy.
• Bypass procedures.
• Amputation.
• Angioplasty – avoid prolonged squatting if stent
in place

16. SPECIAL CONSIDERATIONS
• Some patients may need to begin with 15 min
per day, gradually increasing 5 min per day bi
weekly.
• Supplement weight bearing with non weight
bearing –
arm and leg ergometry.
• Cycling may be used as warm up but not as
primary type of activity.
• Cold environment may aggravate symptoms of
IC therefore longer warm up may be necessary.
• Address all CVD risk factors.

17. REFERENCES
• PAD exercise training toolkit. A guide for health
care professionals. AACVPR.

18. THANK YOU