Peripheral vascular disease (PVD), also known as the peripheral artery disease, refers to stenosis and, ultimately, total occlusion of large arteries outside of the coronaries, aortic arch, and brain by atherosclerotic or inflammatory processes. Despite its high prevalence, it is commonly underdiagnosed and leads to an increased risk of cardiovascular death, major tissue loss, poor quality of life, and higher rates of depression.
Approximately one out of eight adults in the United States have PVD—divided equally between men and women. That number rises to one out of five adults over 70 years of age. Similar to other cardiovascular diseases, the prevalence is higher in African Americans and Latinos as compared to Caucasians in all age groups. Increasing age, diabetes mellitus, and tobacco use are the strongest associated risk factors for PVD (Table 77-1).
TABLE 77-1Risk Factors for PVD |Favorite Table|Download (.pdf) TABLE 77-1 Risk Factors for PVD
|Age ||Men and women older than 65 |
|Diabetes mellitus ||Up to a fourfold increased risk of development of PVD, cardiovascular events, and early mortality. Stronger risk factor in women and African Americans/Hispanics. It is the most common cause for amputation in the United States |
|Tobacco use ||Single most important modifiable risk factor associated with PVD—twice as much as coronary artery disease. Smokers have increased rates of amputation and bypass graft failure vs. nonsmokers. Patients that stop smoking have improved survival |
|Hyperlipidemia ||Associated with a two-fold increase in symptomatic PVD |
|Hypertension ||2.5–4-fold increased risk in both men and women |
Claudication, a cramping pain in the leg induced by exercise, is the classic initial presenting symptom of PVD but up to 60% of patients may be asymptomatic or have atypical leg pain. Symptoms of PVD are summarized in Table 77-2.
TABLE 77-2Symptoms of PVD |Favorite Table|Download (.pdf) TABLE 77-2 Symptoms of PVD
|Classic claudication || |
Pain, cramping, burning in calf, thigh, hip or buttocks—usually one level distal to the obstruction
Disappears after several minutes of rest
Reproduced once same distance has been walked again
|Atypical leg pain || |
|Asymptomatic || |
As PVD progresses, there are both local and systemic events that occur. Local events include worsening claudication, a sign of increasing limb ischemia, which has a poor prognosis and may require revascularization (10%) or, at times, limb amputation (2%). Increasing limb ischemia most commonly manifests as pain at rest but can also present as leg ulcerations or gangrene. Rest pain is worsened with elevation (e.g., lying in bed) and is relieved by standing, sitting, or hanging legs over the side of the bed. Systemic events include cardiovascular events (e.g., myocardial infarction) that are both nonfatal (10%–20%) and fatal (25%). In the majority of ...