Peripheral Vascular Disease
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Article at a Glance
- Peripheral vascular disease is an umbrella term that covers different vascular disorders.
- Peripheral arterial disease is a problem with the arteries, while venous insufficiency is a problem with the veins.
- Read on to learn the pathophysiology and important signs and symptoms of peripheral vascular disease.
This article introduces peripheral vascular disease (PVD). PVD is an umbrella term that covers different vascular disorders. These disorders can affect either the arteries or the veins and present with similar pathology and etiology.Peripheral Vascular Disease
In PVD, the risk factors are essentially the same as those for coronary artery disease. Anything that affects blood vessels can lead to PVD, including factors like: All these factors can lead to injury of the inner lining of the vessels or an endothelial injury. When the endothelium is injured, lipids build up and cause damage, and macrophages rush to the site of the injury and stick there. The macrophages then recruit low-density lipoprotein (LDL), or bad cholesterol, which attracts more LDL, and eventually blocks the artery or vein. LDL and other particles can eventually accumulate and block the blood vessels. The combined injury and accumulation in the blood vessels results in vascular remodeling, or narrowing of the vessels. Eventually, the narrowing of the blood vessels leads to a decrease in blood flow.A Quick Overview of the Pathophysiology of Peripheral Vascular Disease
It is important to distinguish between peripheral arterial disease (PAD) and venous insufficiency.Peripheral Arterial Disease vs. Venous Insufficiency
Related Video – Vascular Resistance Summary
In PAD, there is a perfusion problem with the arteries. The organs that are supposed to be getting perfused are not getting enough blood. When the muscles are not perfused properly, it can lead to intermittent claudication. Intermittent claudication is ischemic pain, usually in the legs, due to the reduced perfusion of blood. Intermittent claudication can cause pain when walking. There are different levels of intermittent claudication, but it starts early in the disease process of PAD. Intermittent claudication occurs intermittently after the patient walks for a prolonged period. When the blood flow is significantly reduced to the feet or the lower extremities, it causes pain. The patient usually needs to rest and let the pain subside. As PAD progresses, those arteries occlude more and more so that the patient may eventually have pain at rest to the point where they are unable to function. PAD affects the appearance of the extremities, including the legs, feet, and distal extremities, which are not being adequately perfused. The extremities will be pale, and the patient will experience paresthesia, or numbness, tingling, and neuropathic pain because of decreased perfusion. Patients will also develop ulcers, which have a distinct punched-out appearance in PAD. These ulcers are typically found on the outer aspect of the ankle. To summarize PAD: Read: Pathophysiology of Increased Intracranial PressurePeripheral Arterial Disease
Related Video – What is Systemic Vascular Resistance?
While PAD affects the arteries, venous insufficiency affects the veins, creating a blood return problem. Veins are responsible for returning blood from the extremities to the heart, but in venous insufficiency, they are unable to do that. One risk factor for venous insufficiency is prolonged standing. The primary classification of venous insufficiency is varicose veins. Varicose veins are a hallmark sign of venous insufficiency. When the veins cannot adequately return blood to the heart, it pools in the extremities and causes edema. That causes pain in the extremities, but it subsides or is relieved with elevation. Elevation helps to return that blood to the heart and also improves the edema. Unlike with PAD, elevation improves venous insufficiency as it assists with return blood flow. Ulcers are also present in venous insufficiency. However, unlike the neat, clean, and tidy ulcers found in PAD, the ulcers in venous insufficiency look much different. Ulcers in venous insufficiency typically occur on the inside of the ankle due to the edema and pooling of blood. These ulcers will have messy edges and a brown-colored drainage. In PAD, patients typically have no hair on their legs because the legs are not being perfused, and hair cannot grow. In venous insufficiency, hair will still be present. PVD is a broad term that covers different vascular disorders. Arterial and venous issues are distinct in their signs and symptoms. In summary, PAD is a problem with artery perfusion. It causes intermittent claudication and presents with neat, punched-out ulcers. Venous insufficiency affects the ability of veins to return blood to the heart. It causes varicose veins and presents with messy ulcers with drainage.Venous Insufficiency
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