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                             PERIPHERAL  VASCULAR  DISEASE

                                                               Andrew Ying-Siu Lee, MD,PhD.

(1)    PERIPHERAL VASCULAR ISCHEMIA :-

(1)   PERIPHERAL ATHEROSCLEROSIS :

       Due to atherosclerosis or inflammation involving peripheral vessels.  Common sites are abdominal

aorta, iliac arteries, thoracic aorta, internal carotid and vertebrobasilar arteries, coronary arteries, femoral

and popliteal arteries.  Risk factors include: age, smoking, family history, hypertension, diabetes mellutis,

hyperlipidemia, obesity, lack of exercise, contraceptives etc.

       The most common symptom is “intermittent claudication”, ie. Cramp like pain in calves, numbness,

weakness when walking a distance, and relieved upon resting.  If the arterial occlusion is severe, patient may

have intermittent claudication even at rest.  Other symptoms include: weak or absent pulses at distal part of

occlusion, pale extremity, discoloration, cyanosis, cold extremity, ulceration or gangrene (necrosis).  Diagnosis

include: ultrasound, computerized tomography (CT), angiography.

       Therapy include: stop smoking and avoid risk factors (most effective), supportive treatment, drugs,

percutaneous transluminal angioplasty or surgery.  For severe ischemic limbs usually with gangrene,

amputation may be considered.

(2)   ACUTE ARTERIAL OCCLUSION:

       Due to thromboembolism.  The heart is the commonest site of throbi formation, if there are chronic or

intermittent atrial fibrillation, acute myocardial infarction, cardiomyopathies, infective endocarditis, heart failure etc.

       Symptoms depend on the sites of arterial occlusion, duration and severity of occlusion.  The affected limbs

usually have severe limb pain, numbness, absent distal pulses, cyanosis, pallor, weakness and cramping.

       Therapy include anticoagulants, percutanous transluminal angioplasty, surgery.

(3)   RAYNAUD’S DISEASE ANDPHENOMENON:

       Predominantly occur in women.  Characterized by spasm of arteries supplying the fingers or toes usually

precipitated by cold and relieved by rest.  There are initial pallor (due to vasoconstriction), then cyanosis (due

to sluggish blood flow) and redness (following hyperemia) of the fingers or toes.  Usually associated with numbness,

burning sensation and severe pain particularly in the rewarming phase.  In severe or persistent cases, trophic

changes of small area of gangrene may occur.

       Primary Raynaud’s disease and phenomenon is idiopathic.  Secondary Raynaud’s disease and phenomenon

may be related to collagen diseases, peripheral vascular ischemia, pulmonary hypertension, neurological diseases,

hematological diseases, trauma (vibration injury, electric or cold injury), drugs, emotional disturbances.

       Majority have mild symptoms, and relieved by quitting smoking and keeping body warm.  Severe cases may

need medical treatment or sympathectomy.

(4) THROMBOANGIITIS OBLITERAN (BUERGER’S DISEASE):

       Usually occurs in young men, related to smoking.  Symptoms include: intermittent claudication, Raynaud's

phenomenon, migratory thromboangiitis, ulceration, gangrene.

       Therapy of Buerger’s disease is similar to that of peripheral vascular ischemia, and stop smoking is definitely important.

(2)   PERIPHERAL VENOUS DISEASE

(1) DEEP VENOUS THROMBOSIS:

       Causes are sluggish blood flow, trauma or hypercoagulability.  Risk factors include: age, obesity, varicose veins,

immobility, pregnancy and puerperium, previous deep venous thrombosis or pulmonary embolism, anticoagulant

disorders, trauma, surgery, malignancy, heart failure, myocardial infarction, stroke, infection etc.

       Symptoms include: pain in calf associated with swelling, redness and engorged superficial veins, edema,

cyanosis, gangrene etc.  The most severe complication is pulmonary embolism.  Diagnosis include: ultrasound,

venography, CT.  Therapy include anticoagulants and thrombolytic agents, as well as prevention of pulmonary embolism.

(2) VARICOSE VEINS:

       Due to superficial venous dysfunction, weakness or pathology.  Symptoms include: calf pain when standing

for long time, edema, ulceration.  Therapy include: elevation of limbs, elastic stocking, prevent prolonged standing,

analgesic, sclerosants and surgery.

(3) SUPERFICIAL THROMBOPHLEBITIS:

       Usually associated with varicose veins.  Symptoms include: painful and tender limbs, edema, ulceration etc. 

Therapy include: elevation of limbs, elastic stocking, analgesic, antibiotics.

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