Peripheral Vascular Disease
Peripheral vascular disease refers to any pathology that affects the blood vessels outside the brain or heart. Peripheral vascular disease is usually the result of atherosclerosis of the blood vessels resulting in insufficient tissue perfusion. Arteries a
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Michael Nguyen and Jackson Cohen
Peripheral vascular disease refers to any pathology that affects the blood vessels outside the brain or heart. Peripheral vascular disease is usually the result of atherosclerosis of the blood vessels resulting in insufficient tissue perfusion. Arteries are more commonly subject to atherosclerotic disease as compared to veins. Peripheral vascular disease is normally a chronic process, but it may present in an acute manner when thrombi, emboli, or acute trauma occur which can affect perfusion. Thromboses often occur in the lower extremities more frequently than in the upper extremities and may result from atherosclerotic plaques [1]. Emboli tend to carry higher morbidity because the extremity has not had time to develop collateral circulation. Whether caused by embolus or thrombus, occlusion results in both proximal and distal thrombus formation due to flow stagnation. Ultimately, this can result in tissue ischemia and necrosis. Peripheral vascular disease is a leading cause of disability among people older than 50 years and in those with diabetes. The number of people M. Nguyen, MD Department of Anesthesia and Perioperative Medicine, Brigham and Women’s Hospital/Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA e-mail: [email protected] J. Cohen, MD (*) Memorial Healthcare System, Hollywood, FL, USA e-mail: [email protected]
with the condition is expected to grow as the population ages. Peripheral vascular disease is associated with significant morbidity and mortality. Prevalence increases dramatically with age, and disproportionately affects the African American population [2]. Men are slightly more likely than women to have the condition. Peripheral vascular disease is more common in smokers, and the combination of diabetes and smoking normally results in more severe disease. Despite its prevalence and cardiovascular risk implications, only 70–80 % of patients will undergo recommended antiplatelet therapy or lipid-lowering therapy [3]. Risk factors for peripheral vascular disease include: • Positive family history of cardiovascular disease • Older than 50 years • Obesity • Inactive (sedentary) lifestyle • Smoking • Diabetes • Hypertension • Hypercholesterolemia • Hypertriglyceridemia Clinical presentation of peripheral vascular disease may be asymptomatic in many cases. However, intermittent claudication may be the sole manifestation of early symptomatic peripheral vascular disease. Aortoiliac disease manifests as pain
© Springer International Publishing Switzerland 2017 R.J. Yong et al. (eds.), Pain Medicine, DOI 10.1007/978-3-319-43133-8_131
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in the thigh and buttock, whereas femoral-popliteal disease manifests as pain in the calf. Symptoms are precipitated by walking a predictable distance and are relieved by rest. Collateral circulation may develop, reducing the symptoms of intermittent claudication, but if peripheral vascular disease is not treated, the collateral circulation will not be able to prevent wor
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