PERIPHERAL VASCULAR DISEASES

PERIPHERAL VASCULAR DISEASES

CAUSES OF PERIPHERAL VASCULAR DISEASES

  1. Atherosclerosis-commonest.
  2. Thromboangitis obliterans.
  3. Collagen diseases.
  4. Syphilis.
  5. Non-specific arteritis.

CLINICAL FEATURES

Age: Above 40 years.

Sex: Usually males predominate

PERIPHERAL VASCULAR DISEASES..There may be pain in the lower limbs which is aggravated after exercise and is relieved by taking rest. This is called intermittent claudication. It is particularly common in lower limbs and diabetes is often associated. Apart form exercise and smoking, cold can also precipitate pain. Gradually when the obstruction is very much pronounced, patient may complain of pain even during rest particularly at night. The temperature of the part is cold, gradually colour of the skin changes, ulceration and gangrene supervene. In some cases there may be spontaneous amputation of the digits.PERIPHERAL VASCULAR DISEASES

ON EXAMINATION

Arterial pulsation

In the upper limbs, axillary, brachial, radial and ulnar arteries and in the lower limbs femoral, popliteal, dorsalis pedis, posterior tibial arteries should be palpated. Pulsations are poor in comparison to those on the unaffected side. It should be remembered that in 10% of the normal subjects dorsalis pedis pulse is present in one side and in about 5% of normal individuals both dorsalis pedis and posterior tibialis pulse may be absent. The pulsations can also be measured hy oscillometey.

Temperature of the limb

By the help of a thermometer or thermocouple, the temperature of the affected limbs can be measured. It will be found to be low in comparison to the healthy side.

Skin changes

There may be colour changes, scaling, drying, ulceration, gangrene, or simple delay in the recovery of blanching. On raising the limb to 45° above the horizontal level, blanching rapidly appears but disappears slowly keeping it at the horizontal position. If a sphygmomanometer cuff is tied (in the above position) in the proximal part of the limb for about 4 minutes and then released, within 10 seconds the flushing appears in normal individuals. But here it will be delayed.PERIPHERAL VASCULAR DISEASES

Changes in vasomotor tone

If the unaffected limb or the trunk is warmed to 42°C there will be no vasodilatation on the diseased limb as should be present in normal individuals.

After injection of Procaine on the anterior spinal root, sympathetic ganglia or in the peripheral nerve the sympathetic fibres will be blocked and there will be flushing and rise of temperature.

INVESTIGATION

  1. Straight X-ray of the limbs may show calcification along the arteries.
  2. Angiography may show the site and degree of obstruction.
  3. Colour Doppler study will also show the obstruction.

TREATMENT OF PERIPHERAL VASCULAR DISEASES

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Smoking, exposure to cold and trauma are to be avoided. Infection in the toes particularly fungal infections should be treated appropriately. If diabetes is present antidiabetic measures should be adopted. Controlled diet is to be instituted for the obese and atherosclerotic individuals. The uninvolved limbs should be kept in a heat cage or cradle-which may give rise to reflex vasodilatation in the affected limb. Antiplatelet drugs, anticoagulants, thrombolytic therapy may be used as the case may be. Pentoxyphylin may be given IV. Surgery: Sympathectomy, arterectomy, embolectomy, bypass surgery, etc. may be performed in selected cases.PERIPHERAL VASCULAR DISEASES