Deep vein thrombosis, 453.8
Occlusive arterial disease, 444.22
Peripheral vascular disease, 443.9
Thromboangiitis obliterans (Buerger’s disease), 443.1
Venous disease, 459.9
I. Definition/Incidence.
A. Disorders of the peripheral arteries and veins
B. Commonly occurs in the lower extremities
C. Affects approximately one in five adults
D. Includes two categories of disease:
1. Peripheral arterial disease (PAD)
2. Chronic venous insufficiency (CVI)
II. Etiology/predisposing factors.
A. Same as for coronary artery disease (see Chapter 10)
III. Peripheral arterial disease (PAD).
A. Subjective/Physical examination findings.
1. The “6 P’s”.
a. Pain—intermittent claudication (i.e., pain to calf, thigh, or buttock)
b. Pallor
c. Pulse absent or diminished
d. Paresthesias
e. Paralysis
f. Poikilothermia
2. Loss of hair on toes or lower legs
3. “Glossy,” thin, cool, dry skin
B. Diagnostic testing.
1. Doppler ultrasound studies
2. Arteriography
C. Management.
1. Embolectomy for emboli to extremities
2. Fibrinolytic therapy for arterial thrombosis
3. Angioplasty, when indicated
4. Pentoxifylline (Trental), 400 mg PO 3 times a day, to decrease viscosity and increase RBC flexibility
5. Aspirin (acetylsalicylic acid [ASA], 81 mg daily, or clopidogrel (Plavix), 75 mg daily, to reduce thrombotic complications
6. Consider cilostazol (Pletal), 100 mg PO twice daily
7. Control contributing factors
a. Diabetes
b. Smoking
c. Hypertension
IV. Chronic venous insufficiency (CVI).
A. Subjective/physical examination findings.
1. Dependent edema to the feet
2. Leg swelling or “tightness”
3. Shiny, taut, hyperpigmented skin
4. Ulcerations or varicosities to legs or feet
B. Diagnostic testing.
1. Doppler plethysmographic studies to measure changes in leg size or volume.
2. Venography
C. Management.
1. Symptomatic treatment
2. Control edema
a. Elevation
b. Support hose
3. Weight reduction, as appropriate
4. Need for meticulous skin care
5. Review medications for agents that may potentially cause edema (e.g., calcium channel blockers).
SPECIFIC DISORDERS
I. Occlusive arterial disease.
A. Arteriosclerosis obliterans.
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1. Definition: narrowing of the lumen in the arteries that results from atherosclerosis
2. Etiology/Incidence.
a. Smoking increases risk twofold.
b. Increased incidence in men (3:1 male-to-female ratio), commonly between ages 50 and 70
c. Femoropopliteal, popliteal-tibial, and aortoiliac vessels (thus, most often lower extremities) are most commonly affected.
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