Peripheral Vascular Disease (PVD) or Peripheral Artery Diseases (PAD) refers to diseases of the circulation that affect the peripheral arteries, which distribute blood in the body other than the heart and brain. PVD is a disease of aging that is already beginning to burden health care and management. It is one of the top four common causes of hospital admissions in general and vascular specialty surgery and intervention in major hospitals. This makes its prevention, detection, diagnosis, and management a serious issue. Lower-limb PVD has a rising prevalence because of the epidemic of type II diabetes and obesity, and an aging population. PVD has serious morbidity, and patients are 2 to 4 times at higher risk for cardiovascular diseases. This mandates an understanding of its mechanisms to promote further exploration of the most effective interventions.
Definition and Types of Peripheral Vascular Disease
Peripheral Vascular Disease (PVD) refers to diseases occurring outside the heart and brain, affecting the peripheral vascular system. It is a blanket term used to describe patients with various diseases. In the broadest sense, PVD may include any disease of the lymphatic or venous systems. Generally, it refers to arterial diseases of the arteries outside the brain, coronary arteries, or aorta. The most common types of PVD are those related to atherosclerosis, which is the degeneration of an arterial wall. PVD can be classified into three types: Peripheral atherosclerotic disease: asymptomatic; symptomatic.
The distinction between these types is not absolute; they may share many of the risk factors and clinical features, and people with one type may develop another. The interplay of genetic, demographic, and environmental factors contributes to arterial damage. When the rate of arterial damage exceeds the repair process, our small arteries become damaged, obstructing blood flow, and symptoms of insufficient blood flow and interrupted arterial supply will follow.
Understanding the Risk Factors
Peripheral Vascular Disease (PVD) is a multifaceted disease characterized by the inflammatory response in the delicate circulation of peripheral arterioles, capillaries, and venules. PVD is also significantly associated with both localized and forecasting atherothrombotic vascular occurrences such as cerebrovascular disease, ischemic heart failure, coronary artery disease, and chronic kidney disorders. Still, a range of putative or scientifically validated risk factors tends to contrast with larger systemic vascular events such as coronary and cerebrovascular events that show a significant link with atherosclerosis. Vascular researchers and practitioners are gradually educating themselves about the risk factors of PVD that are closely related to the blockage of segmental existence of peripheral vessels at the time of symptoms. Risk factors can be understood as conditions or behaviors that contribute to the progression of a disease either by affecting the normal operation of the body or by promoting the development of conditions that predispose an individual.
Diagnostic Approaches at Vascular and Interventional Centre
The timely and accurate diagnosis of peripheral vascular disease (PVD) is now of great importance when it comes to achieving optimal patient outcomes. Patients suffering from PVD may present with a variety of signs and symptoms including, but not limited to, leg discomfort, impalpable distal pulses, skin ulceration, and a history of risk factors such as ischemic heart disease. A thorough evaluation of limb perfusion must, therefore, occur when dealing with patients in whom PVD is being considered as a differential diagnosis. In order to advance patient care and provide holistic management, the Vascular and Interventional Centre at our institution works to integrate innovations and advancements in imaging with clinical appraisal in order to diagnose this diverse patient group accurately.
A multitude of diagnostic tests are available and have been put to use in diagnosing PVD, each with its own strengths and weaknesses. These diagnostic approaches include but are not limited to the use of ultrasound, angiography, and magnetic resonance imaging (MRI). The strengths and limitations of each vary, and the quality of imaging can be operator dependent as well as patient specific. As laboratory-based tools, certainly computer tomographic angiography (CTA) or angiography (invasive or non-invasive) can complement clinical assessment, in conjunction with duplex, computed tomography (CT), or magnetic resonance (MR) imaging to provide a comprehensive understanding. It is, however, imperative that diagnosis and management occur in a multidisciplinary setting and not in isolation.
Minimally Invasive Interventions
Minimally invasive interventions play a vital role in treating peripheral arterial disease (PAD). Minimally invasive surgery is offered to patients as it reduces the point of catheter placement with the advantage of administering anesthesia in the groin or through the arterial route. Compared to bypass surgery, the recovery time is also significantly reduced in minimally invasive surgery, with the need for fewer pain medications. Complication rates, including heart attack rates, can also be lower with percutaneous interventions. An array of minimally invasive interventions is available, each offering its own advantages. Some of the commonly performed interventions angioplasty and/or stenting.
Not all patients are candidates for minimally invasive therapy, and this decision is based on a case-by-case basis as well. Patients’ specific factors may dictate conventional therapy for their ability to benefit from any attempted minimally invasive approach. Advances in technology over the past two decades have made it possible for more patients to undergo a percutaneous option for the management of peripheral artery disease. A well-coordinated healthcare team can facilitate clinics where minimally invasive therapy can be considered. These clinics may include interventionists and surgeons, where your vulnerability to anesthesia and medication is taken into account when determining an approach to treatment.
Angioplasty and Stenting
Angioplasty is one of the key procedures by which a radiologist or vascular surgeon treats Peripheral Vascular Disease. The basic technique involves puncturing an artery in the groin and passing a catheter into the blocked blood vessel. The narrowings due to plaque are then dilated using a balloon catheter. Most angioplasties involving the blood vessels of the legs and, in some cases, the aorta are carried out as simple single-day case surgeries. More serious blockages may require admission to the hospital for repeat or complex angioplasties and, in some cases, a combination of open surgical procedures. Stents are expandable coils, mesh, or slotted metal tubes that are mounted on balloons, expanded within the artery to act in the short or long term to maintain the patency of a vessel. Modern stents are drug-eluting and aid in reducing re-stenosis from excessive reaction following angioplasty, which will be a reaction to the small amount of trauma that the vessels generally have to be able to expand them.
The procedure can involve the left or right groin or the arm approach. Technical success rates are 93-94% for aorto-iliac angioplasty, 80-90% for SFA/popliteal angioplasty, and above 90% for angioplasty in most below-knee arteries. The advantages of angioplasty and stents include that more than 90% of people report minimal to moderate pain and short admissions; also, a significant number indicate rapid return to normal activity, most often within 24-48 hours. Complications include blockage of the artery, which in most cases requires another angioplasty or stenting to fix; about 1 in 100 will go to open surgery for the repair, and approximately 3% will have an access site problem, mainly from the groin. In some clinics, they can almost eliminate this problem by the use of special devices that stop the bleeding instantly. Careful selection of outcomes is important in ensuring that the right person can benefit the most. Patients with claudication or limb strain are patients who have blockages in their arteries that give symptoms of pain on semi-automated walking, and this occurs mostly between 60 and 200 meters for one or both legs. Pain will resolve on rest in almost 90% of patients. The aim of the treatment would be to improve function and quality of life.
Post-Procedure Care and Follow-Up
Post-procedural care is as important as the procedure itself. All patients are to be monitored post-procedure for the development of vascular complications. Close observation ensuring the patient receives any necessary care for successful healing and recovery is part of the overall treatment. Supervised post-intervention care and encouragement of daily activities allow for an appropriate progression of recovery. All patients are seen in consultation after the first three months of the intervention for follow-up and surveillance, even if their clinical symptoms have improved.
