Peripheral vascular disease: Clinical

Peripheral vascular disease is an abnormal narrowing of arteries other than the ones that supply the heart or brain, and it most often affects the ones in the legs.

Risk factors include being older than 60 years, smoking, hypertension, hyperlipidemia, diabetes, and metabolic syndrome.

The most common underlying mechanism of peripheral artery disease is atherosclerosis, which results in the accumulation of lipid and fibrous material between the layers of the arterial wall.

Eventually, the affected artery becomes progressively narrower, and this may lead to pain, ulceration, and even gangrene.

Now, most people with peripheral vascular disease actually don’t have symptoms until occlusion becomes significant, which is when 70% of the vessel lumen is obstructed.

Symptoms include intermittent claudication, which includes pain, numbness, or tiredness in the legs during walking or standing, and is relieved by rest.

This is because the blood supply may be enough to meet the muscle needs at rest, but not the increased needs during activity, leading to ischemia – so basically, occurs when oxygen demand is greater than oxygen supply.

The perceived level of symptoms from intermittent claudication can be mild to extremely severe depending on the degree of blood supply.

Intermittent claudication can present unilaterally or bilaterally, as buttock and hip, thigh, calf, or foot pain, singly or in combination.

In addition, pulses in one or both groins are diminished, and bilateral aortoiliac disease that is severe enough almost always causes erectile dysfunction.

The triad of intermittent claudication, absent or diminished femoral pulses, and erectile dysfunction is known as Leriche syndrome.

Location of pain depends upon the artery involved. Lower aorta or iliac artery involvement causes pain in the hips and buttocks.

Iliac or common femoral artery involvement causes pain in the thigh.