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Peripheral vascular disease - Coggle Diagram
Peripheral vascular disease
Overview
Definition
Progressive narrowing or occlusion of lower extremity arteries.
Anatomy
Aortoiliac segment (Leriche syndrome).
Femoropopliteal segment (most common site).
Tibial segment (common in diabetes and elderly).
Pathophysiology
Primary Mechanism
Intimal plaque accumulation leading to arterial stenosis.
Downstream Effect
Impaired distal blood flow causing tissue ischemia.
Risk Factors
Non-Modifiable
Increasing age.
Male sex.
Family history of cardiovascular disease.
Modifiable
Active or past smoking.
Diabetes mellitus.
Hypertension.
Dyslipidemia.
Chronic kidney disease.
Clinical Presentation
Asymptomatic Disease
Identified via screening or absent pulses without pain.
Intermittent Claudication
Exertional muscle pain relieved by rest.
Ischemic Rest Pain
Continuous burning nocturnal forefoot pain relieved by dependency.
Critical Limb-Threatening Ischemia
Chronic rest pain, non-healing ulcers, or gangrene.
Physical Examination
Inspection
Pale, shiny, hairless skin and thickened nails.
Dependent rubor and elevation pallor.
Ischemic ulcers or necrotic tissue.
Palpation
Cold lower extremity.
Diminished or absent lower limb pulses.
Capillary refill time exceeding 2 seconds.
Clinical Testing
Positive Buerger test.
Diagnostic Testing
Non-Invasive Bedside Tests
Ankle-Brachial Pressure Index (ABPI):
Normal range: 0.9 to 1.3
Mild to moderate disease: 0.5 to 0.89
Severe disease: less than 0.5
Vessel calcification: greater than 1.4
Toe-Brachial Index (TBI).
Imaging Studies
Duplex ultrasound.
CT angiography or MR angiography.
Digital subtraction angiography.
Medical Management
Risk Factor Modification
Antiplatelet therapy (clopidogrel).
High-intensity statin therapy.
Blood pressure and glycemic control.
Lifestyle Interventions
Complete smoking cessation.
Supervised exercise therapy programs.
Targeted Medications
Naftidrofuryl oxalate or Cilostazol for claudication.
Surgical Management
Endovascular Interventions
Percutaneous transluminal angioplasty.
Stent insertion or atherectomy.
Open Surgical Procedures
Surgical bypass grafting.
Endarterectomy.
End-Stage Management
Amputation for non-viable tissue or severe infection.