Peripheral vascular disease: pathophysiology and clinical management

¶ … Vascular Disease

Randy Jackson

Geriatric Nursing

The disease known as Peripheral Vascular Disease (PVD), according to the American Heart Association (AHA, 2004), involves the blood vessels "outside the heart and brain." This disease refers to a narrowing of those vessels that carry blood to one's leg and arm muscles.

In particular, the AHA states that there are two forms of PVD: one is "Functional Peripheral Vascular Disease," and the other is "Organic Peripheral Vascular Disease." The first, Functional PVD, does not allude to actual defects in the structure of the blood vessel, but rather refers to "short-term effects" caused by cold temperatures, stress caused by emotions, smoking, or handling machinery that vibrates powerfully.

The second form of PVD - "Organic" - is actually caused by "structural changes" in blood vessels. These changes may be inflammation, tissue damage, or the buildup of fatty substances in the arteries, called "atherosclerosis" - which restricts good blood flow to the body's limbs. Atherosclerosis is particularly insidious in its attack on one's health because people "are unaware of the disease process" (Barker, et al., 2003) until "nearly 75% of the artery is occluded." And unlike "Functional" PVD, these above-mentioned changes in vessels are not temporary.

What are the signs and symptoms of PVD? According to the Townsend Letter for Doctors and Patients (Barker, et al., 2003), there are "many predisposing factors," including: High Blood Pressure; Diabetes; a family history of members with diabetes or other cardiovascular issues such as stroke, myocardial infarction and hypertension; "Aching or cramping in the legs while exercising that resolves upon rest"; pain in the feet or toes at night; wounds that heal slowly; a history of smoking cigarettes; being overweight; the regular consumption of fried and heavily-fatty foods; and a lack of regular exercise.

Some two million people currently suffer from PVD, according to Meletis, and PVD is the "leading cause of amputations" in the U.S. One of the debilitation effects of PVD is stasis ulcers - those are ulcerations that appear on legs as a result of reduced blood flow through legs; the age group most closely associated with stasis ulcers is the elderly. One way to lesson the severity of stasis ulcers is through increased physical activity, which helps increase circulation.

Another important element in terms of lessening the effects of hardening of the arteries in the legs, according to the Society of Interventional Radiology (PR Newswire, 2003), is to quit smoking. "PVD is caused by atherosclerosis, which is often due to smoking," the article states. Those blocked leg arteries "can result of stroke or heart attack."

Two hopeful and positive treatments for PVD are now being used for PVD patients. The Food and Drug Administration approved a new procedure called "CryoPlasty" in late 2003. CryoPlasty (Knight-Ridder, 2004) is quite similar to "balloon angioplasty," with one major difference: in CryoPlasty, the balloon "is filled with pressurized nitrous oxide instead of saline solution." So, the gas freezes the walls of the artery for a few seconds, which, the article reports, reduces the chance of blockage "due to damage inflicted by the balloon." Doctors who have used CryoPlasty say it is a 45-minute procedure, and patients remain awake.