![]() ![]() Additional studies such as duplex ultrasonography, magnetic resonance arteriography, and angiography are indicated for determining lesion localization and are best used when invasive or surgical intervention is a possibility. 12 Although elevated homocysteine, C-reactive protein, and lipoprotein A levels are risk factors for PVD, there are no outcomes studies to demonstrate that lowering these levels leads to clinical benefit for patients with PVD. 12 Further laboratory studies, including those for coagulopathies, are reserved for atypical situations. Laboratory studies to be ordered at the time of diagnosis include complete blood count with platelet count, fasting glucose or A1C, fasting lipid profile, serum creatinine, and urinalysis for glucosuria and proteinuria. 11 ABI testing, which requires a blood pressure cuff and a Doppler device with a probe for detecting arterial pulses, may be performed in the office or hospital setting. The ABI will not exclude proximal aneurysms or arterial disease distal to the ankle. The presence of an ABI less than 0.9 is consistent with PVD. Once PVD is suspected, physicians can screen patients using ABI testing on one or both extremities. ![]() History of iliofemoral deep venous thrombosis, signs of venou congestion and edema Subsides after some time accompanied by position change (e.g., sitting down) Varies, may relate more to activity level or weather changes Patients with PVD and hypercholesterolemia should be treated with appropriate dietary modification and lipid-lowering agents, as needed.Īggressive blood pressure reduction should be pursued in patients with PVD. The laboratory work-up at time of diagnosis should include a complete blood count with platelet count, fasting glucose or A1C, fasting lipid profile, serum creatinine, and urinalysis for glucosuria and proteinuria.ĭuplex ultrasonography, magnetic resonance arteriography, and angiography are indicated for determining lesion localization in PVD and are best used when invasive or surgical intervention is a possibility.Įxercise has been shown to increase the walking time of patients with claudication by 150 percent (i.e., 6.51 minutes).Īspirin reduces risk of serious vascular events in patients with PVD, with doses of 75 to 150 mg being as effective as higher doses. The most reliable physical findings of PVD are diminished or absent pedal pulses, presence of femoral artery bruit, abnormal skin color, and cool skin temperature. ![]() Surgical therapies include stents, arterectomies, angioplasty, and bypass surgery. In addition, patients with contributing disorders such as hypertension, diabetes, and hyperlipidemia need to have these conditions managed as aggressively as possible. Medical therapy is directed at reducing platelet aggregation. Lifestyle therapies focus on exercise, smoking cessation, and dietary modification. Treatment is divided into lifestyle, medical, and surgical therapies. Contrast arteriography is used for definitive localization before intervention. Magnetic resonance arteriography, duplex scanning, and hemodynamic localization are noninvasive methods for lesion localization and may be helpful when symptoms or findings do not correlate with the ankle-brachial index. The standard office-based test to determine the presence of peripheral vascular disease is calculation of the ankle-brachial index. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult. Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color. Intermittent claudication manifests as pain in the muscles of the legs with exercise it is experienced by 2 percent of persons older than 65 years. At other times, peripheral vascular disease leads to acute or critical limb ischemia. The most common symptom of peripheral vascular disease is intermittent claudication. Peripheral vascular disease is a manifestation of systemic atherosclerosis that leads to significant narrowing of arteries distal to the arch of the aorta. ![]()
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