Peripheral vascular disease (PVD) or Peripheral arterial disease (PAD)

Cardiology (12%) Core Clinical Conditions

1B: Able to identify the condition as a possible diagnosis: may not have the knowledge or resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Peripheral arterial disease (PAD) is caused by atherosclerosis or the accumulation of fatty deposits in the arteries, which causes the arteries in the legs and feet to narrow and impede blood flow. This restricted blood flow can cause discomfort and agony, especially during vigorous exercise, and can also raise the risk of ulcers and infections.

Atherosclerosis, is a disorder in which fatty deposits called plaque develop in the arteries and reduce blood flow, is the leading cause of PAD.

Atherosclerosis is caused by genetics, the environment, smoking, hypertension, excessive cholesterol, obesity, a sedentary lifestyle, and a family history of peripheral arterial disease (PAD).

PAD is caused by inflammation in the artery walls, which damages the inner lining of the arteries. This results in the buildup of additional fatty deposits and the deterioration of the disease.

Additional causes of PAD include arterial damage, blood clots, and idiopathic reasons.

1. Atherosclerosis causes a constriction of the arteries in the legs and feet.

2. Plaques develop as artery wall thickness increases (which could lead to ischemia)

3. Inflammation of the artery walls prompts immune cells such as macrophages and monocytes to release toxins that exacerbate vessel damage.

• Smoking

• Diabetes 

• Hypertension 

• Hypercholesterolemia 

• Family history of PAD

• Pain or cramping sensation in the feets/legs during exertion. 

• Cold limbs or pin/needles sensation in feets/toes

• Sore and/or wounds that won't heal

• Weak or absent pulses in the legs or feet on examination.

• Physical examination + symptoms 

• Ankle-brachial index (ABI): a basic measurement used to compare ankle and arm blood pressure. A low ABI value suggests the presence of PAD. Normal is 1, claudication is 0.6 to 0.9, rest pain is 0.3 to 0.6, and imminent gangrene is 0.3 or less.

• Duplex ultrasound: using sound waves, duplex ultrasonography creates images of the arteries in the legs and feet. It can evaluate blood flow and discover blockages or constriction of the arteries.

• Computed tomography angiography (CTA) or magnetic resonance angiography (MRA): These are imaging techniques that provide detailed images of the blood arteries in the legs and feet using contrast dye and specialised scanners. They can identify the location and degree of any arterial blockages or constriction.

• Angiogram: contrast dye is injected into the arteries, and X-rays are then obtained to see the blood vessels. It can help pinpoint the exact position and amount of the blockages in the arteries.

• Blood tests: lipid profile, Hba1c, and kidney function tests.

• Lifestyle changes: smoking cessation, a nutritious diet, and regular exercise.

• As a PA you should refer to vascular.

• Medications: antiplatelet drugs, such as aspirin or clopidogrel, to minimise the risk of blood clots, statins to lower cholesterol levels, and drugs to control high blood pressure or diabetes.

• Endovascular procedures: a catheter and specialised instruments are used to open or remove arterial obstructions, allowing for increased blood flow.

• In severe circumstances, surgical techniques are utilised to bypass or remove the obstructed part of the artery.

• Wound care: whether there are ulcers or other lesions on the feet or legs, wound treatment is necessary.

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