Peripheral vascular disease (PVD)

What are the clinical settings when you would consider peripheral arterial occlusion?

• Mode of presentation
  • When a patient presents with intermittent claudication, impotence or gangrene of extremities
• Physical findings
  • On auscultation, one may hear a bruit over the stenotic vessel. However, a completely occluded vessel will not produce a bruit. Decreased or absent pulse.
• Risk factors
  • Coronary artery disease, peripheral vascular disease, and carotid artery disease are all different manifestations of atherosclerosis. When one is present others should be suspected.

Suspicion and workups for peripheral artery disease should be initiated because of symptoms of vascular insufficiency or bruit over a vessel or because of the presence of another atherosclerotic manifestation, e.g., coronary artery disease.

Describe clinical presentation of occlusion of abdominal aorta at its bifurcation.

• Occlusion of the abdominal aorta will result in hypoperfusionl distal areas including the lower abdomen, the pelvis, and both lower extremities.
• This will cause symptoms depending on the severity of the stenosis or occlusion.
• Impotence, intermittent claudication, poorly healing ulcers, distal ischemia, and gangrene are common sequela.

Describe the clinical presentation of chronic peripheral vascular disease.

• Chronic PVD often presents with intermittent claudication, which is pain in a localized area of the lower extremity following exercise that is relieved by rest.
• Calf claudication is secondary to insufficiency of the femoral or popliteal arteries.
• Claudication in the thighs and buttocks occurs with disease of the iliac vessels.
• PVD is often accompanied by widespread atherosclerotic disease.
• Patients may have experienced prior transient ischemic attacks or cerebral vascular accidents.
• They may have coronary artery disease.
• Males may complain of impotence, as the penile vessels are affected by vascular disease as well.

What are the available imaging procedures to investigate peripheral vascular disease?

• Doppler ultrasound is an effective and noninvasive imaging modality of detecting PVD and is the first line method of imaging to detect PVD.
• For more definitive studies, angiography, computed tomography (CT) angiography, duplex scanning, and magnetic resonance (MR) angiography are the current available vascular imaging modalities.
• Arteriography is the gold standard imaging procedure to assess PVD.
• However, angiography is an invasive procedure that requires contrast administration.