Peripheral Vascular Disease

Peripheral Vascular Disease (PVD) is a blood circulation disorder that leads to the narrowing, blockage, or spasm of blood vessels outside the heart and brain. The narrowing can happen to both arteries and veins, and typically reduces the distribution of oxygen and nutrients, as well as, the evacuation of wastes among other effects to affected parts of the body. The narrowing is as a result of occlusion by atherosclerotic plaques of the blood vessels. 

Common Signs and Symptoms of PVD

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The complication manifests itself through fatigue and cramping of legs and feet. Physical activity will worsen the pain in the feet due to constricted blood flow as observed by Murphy et al. (2015). Further, the legs have reduced hair growth and one experiences muscle cramps, especially while lying in bed. The legs of a patient might turn reddish blue or pale due to insufficient supply of oxygenated blood to tissues in the legs. According to de Franciscis (2015), patients might get ulcers in their feet, especially if they have diabetes. The muscles of a patient feel numb. The most pronounced problem is claudication as expressed by Jaff et al. (2015). With claudication, a patient experiences intense pain on the lower limb muscles, especially while walking. 

Screening Assessment Tools and Recommended Diagnostic Tests

There are several diagnostic tests available for clinicians. The first is the Ankle-Brachial Index (ABI), which according to O’Meara, Connolly, Byrne, Egan, and Tierney (2018), is a simple and non-invasive test that is often the first choice for clinicians. It involves the comparison of the systolic blood pressure of the ankle and that of the arm and the ratio of the two informs the physician of the PVD risk. The second is the Doppler Ultrasound as expressed by Gupta, Tyagi, Bansal, Virmani, and Sirohi (2017). The third is the use of the angiogram, which combines the use of dye in the bloodstream and x-ray of CT-Scan imaging to observe the movement of the dye as expressed by Shafqat-ul-Islama and Raza (2016).

Treatment Plans both Pharmacologic and Non-Pharmacologic based on Current Clinical Practice Guidelines

According to Bonaca and Creager (2015), when it comes to pharmacological intervention, statin therapy is recommended as it reduces adverse cardiac events. For patients that are less than 75 years, Bonaca and Creager (2015) recommend the use of atorvastatin 40-80mg or rosuvastatin 20-40 mg. Further, the use antihypertensive therapy, especially the angiotensin-converting enzyme inhibitors (ACE-I), as well as, angiotensin-receptor blockers (ARB), were identified to offer benefits for systemic cardiovascular event reduction in patients if used in less than 140/90mm Hg. Non-pharmacologic interventions of PVD include smoke cessation and exercise programs, which include walking. Patients are further advised to reduce obesity and adopt active and healthy lifestyles. Optical medical therapy is also advocated as identified by Bonaca and Creager (2015). 

In conclusion, PVD patients might take time before realizing that they need medical attention. Once the symptoms start showing, patients experience feet and leg problems, as well as, muscle tiredness and cramps. To correctly diagnose the problem, different tools and tests are available, such as the Ankle-Brachial Index, Doppler Ultrasound, and the angiogram can be used. Pharmacological and non-pharmacological test are available in the management of the complication. 

References

Bonaca, M. P., & Creager, M. A. (2015). Pharmacological treatment and current management of peripheral artery disease. Circulation research, 116(9), 1579-1598.

de Franciscis, S., Gallelli, L., Battaglia, L., Molinari, V., Montemurro, R., Stillitano, D. M., … & Serra, R. (2015). Cilostazol prevents foot ulcers in diabetic patients with peripheral vascular disease. International wound journal, 12(3), 250-253.

Gupta, A., Tyagi, V. K., Bansal, N., Virmani, S. K., & Sirohi, T. R. (2017). Comparison of ankle brachial pressure index to arterial doppler USG in the diagnosis of peripheral vascular disease in diabetes mellitus. International Journal of Advances in Medicine, 4(6), 1562-1565.

Jaff, M. R., White, C. J., Hiatt, W. R., Fowkes, G. R., Dormandy, J., Razavi, M., … & Norgren, L. (2015). An update on methods for revascularization and expansion of the TASC lesion classification to include below-the-knee arteries: a supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Annals of vascular diseases, 8(4), 343-357.

Murphy, T. P., Cutlip, D. E., Regensteiner, J. G., Mohler, E. R., Cohen, D. J., Reynolds, M. R., … & Thum, C. C. (2015). Supervised exercise, stent revascularization, or medical therapy for claudication due to aortoiliac peripheral artery disease: the CLEVER study. Journal of the American College of Cardiology, 65(10), 999-1009.

O’Meara, S., Connolly, M., Byrne, L., Egan, B., & Tierney, S. (2018). AB040. 69. The use of the oscillometric measurement of ankle-brachial pressure indices as a screening tool for the peripheral arterial disease. Mesentery and Peritoneum, 2(2).

Shafqat-ul-Islam, S., & Raza, S. (2016). Peripheral vascular disease evaluation by multidetector CT angiography: initial experience. PJR, 18(2).

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