Peripheral vascular diseases

Peripheral vascular diseases

1. Blood vessels of the lower limbs

   • Arteries
     • Veins

2. Vasculitis

   • Large vessels
     • Giant cell (temporal arteritis)
       • Elderly female, headache, jaw claudication
       • Could lead to blindness (ophthalmic artery)
     • Takayasu arteritis
       • Asian young female
       • Pulseless disease, fever, night sweats
   • Medium vessels
     • Polyarteritis nodosa
       • Kawasaki disease
         • Buerger disease
           • Heavy smoker, young male
             • Gengrene, autoamputation of digits
         • Asian children less than 4 years old, affecting skin, lips, tongue
       • Middle-aged men, Hep B in 30%, immune mediated
       • Nerves, skin, kidneys
   • Small vessels
     • Wegener
       • Microscopic polyangiitis
         • Churg-Strauss
           • Henoch-Schonlein purpura
             • Most common childhood systemic vasculitis
               • Classic triad: palpable purpura, arthralgia, GI problems
           • Asthma in adults, pouch-immune
           • p-ANCA positive, high IgE levels
             • Eosinophilia
         • Similar to Wegener but no granuloma or nasopharungeal involvement
         • p-ANCA positive
       • affecting both upper and lower respiratory tracts
       • c-ANCA positive

3. Atherosclerosis

   • Risk factors
     • Tobacco smoke
       • Hereditary
         • Endocrine
           • Obesity
             • Males
               • Age
                 • Stress
     • Pathogenesis
       • endothelial cell dysfunction
         • macrophage and LDL accumulation
           • Foam cell formation
             • fatty streaks
               • smooth cell migration
                 • proliferation and extracellular matrix deposition
                   • fibrous plaque
                     • complex atheroma

4. Intermittent claudication

   • A symptom of PAD characterized by pain, aching, or fatigue in exercising leg muscles

5. Aortic dissection

   • Intimal tear with dissection of blood through media of the aortic wall

6. Aneurysms

   • Thoracic
     • compression of mediastinal structures
       • Abdominal
         • Primarily due to atherosclerosis

7. Investigations

   • ABI index
     • Duplex US
       • photoplethysmogram

8. Management

   • Smoking cessation
     • Excersice
       • Statins (anti-heperlipidemics)

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