APA Peripheral Vascular Disease Essay Paper
Arteries deliver oxygen-rich blood from the heart to every part of the body, and the peripheral arteries carry blood away from the heart to the arms and legs. Peripheral Arterial Disease (PAD) develops when these arteries begin to build up plaque, obstructing and narrowing the passageway and preventing blood, oxygen, glucose from flowing to the legs. The buildup of fat, cholesterol and other substances causes of the pain and discomfort patients experience in their legs as the muscles and tissue starve for blood. Just like how the build up of plaque in the heart causes a heart attack, blocked blood flow in the legs causes a “heart attack” of the tissue and muscle in the legs and can lead to the death of the limb and ultimately the need for amputation.APA Peripheral Vascular Disease Essay Pape
If lifestyle modifications and medications are not enough to treat PAD, our physicians at Pedes Orange County utilize a combination of Angiogram, Atherectomy, Stenting, and Angioplasty to restore healthy blood flow through the arteries to all parts of your feet and legs. Our physician can also address arterial obstruction that occurs in other arteries such as in the arms or the renal artery that carries blood to the kidneys.
Peripheral arterial disease (PAD), also called “peripheral vascular disease” or “claudication,” occurs when blood flow to the legs is reduced or completely blocked by atherosclerosis (hardening of the arteries). When blood flow to one or both legs can’t keep up with demand, the result is leg pain while walking (“intermittent claudication”) and other symptoms. If blood flow to the legs is completely blocked, tissues in the leg and/or foot die, increasing the risk of amputation.APA Peripheral Vascular Disease Essay Paper
Although PAD most frequently affects the legs and feet, it can also affect arteries that carry blood from the heart to the head, arms, heart and other internal organs. According to the US National Heart, Lung, and Blood Institute, PAD affects 8 to 12 million people in the United States, especially those over the age of 50. According to The Lancet medical journal, as of 2010, the number of people with PAD is estimated at 202 million world-wide.
If peripheral vascular disease (PVD) occurs only in the arteries, it is called peripheral artery disease (PAD). Most cases of PVD affect the arteries as well, so the terms are often interchangeable.
In this article, we take a close look at PVD, including causes, symptoms, diagnosis, and treatments.
Fast facts on PVD:
- PVD affects an estimated 1 in 20 Americans over 50 years of age.
- Common risk factors include being over 50, smoking cigarettes, and having high blood pressure or high cholesterol.
- Common symptoms include pain and cramps in the legs, hips, and buttocks.
- According to the Centers for Disease Control and Prevention (CDC), PVD affects men and women equally.
- Arteriosclerosis and atherosclerosis are among the most common causes of PVD.APA Peripheral Vascular Disease Essay Paper
Types of peripheral vascular disease
There are two main types of PVD:
- Organic PVD results from changes in the blood vessels caused by inflammation, plaque buildup, or tissue damage.
- Functional PVD happens when blood flow decreases in response to something that causes the blood vessels to vary in size, such as brain signals or changes in body temperature. In functional PVD, there is no physical damage to the blood vessels.
Signs and symptoms of PVD often appear gradually. They occur more commonly in the legs than the in arms because the blood vessels in the legs are further from the heart.
Pains, aches, or cramps while walking are typical symptoms of PVD. However, up to 40 percent of people with PVD or PAD do not experience any leg pain.
Pains, aches, and cramps related to walking, which is known as claudication, might occur in the following areas:
Symptoms of claudication often develop when someone is walking quickly or for long distances. The symptoms typically go away with rest. However, as PVD progresses, symptoms can get worse and become more frequent. Leg pain and fatigue may persist even while resting.APA Peripheral Vascular Disease Essay Paper
Other symptoms of PVD include:
- leg cramps when lying down
- pale or reddish-blue legs or arms
- hair loss on the legs
- skin that is cool to the touch
- thin, pale, or shiny skin on the legs and feet
- slow-healing wounds and ulcers
- cold, burning, or numb toes
- thickened toenails
- slow or absent pulse in the feet
- heavy or numb sensations in the muscles
- wasting away of the muscle (atrophy
Causes of PVD vary and depend on the type a person has.
Causes of organic PVD
Arteriosclerosis, which is caused by changes in the structure of the blood vessels, is a common cause of organic PVD.
Atherosclerosis, which is a specific type of arteriosclerosis, occurs when plaque (fats and other substances) build up in the blood vessels. Atherosclerosis can restrict blood flow, and if left untreated, can cause clots. Clots block the arteries and cause loss of limbs or organ damage.
Common risk factors for atherosclerosis include:
- high blood pressure (hypertension)
- high cholesterol or triglycerides
- inflammation from arthritis, lupus, or other conditions
- insulin resistance
The following conditions may cause structural changes in the blood vessels:
- Buerger’s disease
- chronic venous insufficiency
- deep vein thrombosis (DVT)
- Raynaud’s syndrome
- varicose veins
Injury, inflammation, or infection in the blood vessels may also cause structural changes in the blood vessels.
Causes of functional PVD
Functional PVD occurs when blood vessels have an increased response to brain signals and environmental factors. Common causes of this include:APA Peripheral Vascular Disease Essay Paper
- cold temperatures
- drug use
- feeling stressed
- using machines or tools that cause the body to vibrate
Smokers and people over the age of 50 are at an increased risk of developing PVD.
In general, the risk factors for PVD are similar to those for arteriosclerosis. They include:
- Age. People aged 50 years and over are more likely to get PVD and PAD.
- Being overweight or obeseincreases risk of arteriosclerosis, PVD, and other cardiovascular conditions.
- Lifestyle choices. People who smoke, use drugs, avoid exercise, or have an unhealthful diet are more likely to get PVD.
- Medical and family history. PVD risk rises for people who have a history of cerebrovascular disease or stroke. Those with a family history of high cholesterol, hypertension, or PVD are also at higher risk.
- Other medical conditions. People with high cholesterol, hypertension, heart disease, or diabetes are at an increased risk of developing PVD.
- Race and ethnicity. African American people tend to develop PVD more frequently.
If a person suspects they have PVD, it is essential that they see a doctor. Early diagnosis and treatment can improve the outlook for the disease and prevent severe complications from occurring.APA Peripheral Vascular Disease Essay Paper
A doctor will diagnose PVD by:
- Taking a full medical and family history, which includes details of lifestyle, diet, and medication use.
- Performing a physical examination, which includes checking the skin temperature, appearance, and the presence of pulses in the legs and feet.
They may also order tests to confirm a diagnosis or rule out other conditions. Several other disorders can mimic the symptoms of PVD and PAD.
Diagnostic tests used to diagnose PVD include:
- Angiography. Angiography involves injecting dye into the arteries to identify a clogged or blocked artery.
- Ankle-brachial index (ABI). This non-invasive test measures blood pressure in the ankles. The doctor then compares this reading to blood pressure readings in the arms. A doctor will take measurements after rest and physical activity. Lower blood pressure in the legs suggests a blockage.
- Blood tests. Although blood tests alone cannot diagnose PVD, they can help a doctor check for the presence of conditions that can increase a person’s risk of developing PVD, such as diabetes and high cholesterol.
- Computerized tomography angiography (CTA). A CTA imaging test shows the doctor an image of the blood vessels, including areas that have narrowed or become blocked.
- Magnetic resonance angiography (MRA). Similar to a CTA, magnetic resonance angiography highlights blood vessel blockages.
- Ultrasound. Using sound waves, an ultrasound allows the doctor to see blood circulation through the arteries and veins.APA Peripheral Vascular Disease Essay Paper
Peripheral vascular disease (PVD) is a nearly pandemic condition that has the potential to cause loss of limb or even loss of life. PVD manifests as insufficient tissue perfusion initiated by existing atherosclerosis acutely compounded by either emboli or thrombi. Many people live daily with significant degrees of PVD; however, in settings such as acute limb ischemia, this latent disease can suddenly become life-threatening and necessitate emergency intervention to minimize morbidity and mortality.[1, 2]
Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD most commonly affects arteries in the legs.
Both PAD and coronary artery disease (CAD) are caused by atherosclerosis. Atherosclerosis narrows and blocks arteries in critical regions of the body.APA Peripheral Vascular Disease Essay Paper
Quick facts about PAD
The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.
Be aware that:
- Many people mistake the symptoms of PAD for something else.
- PAD often goes undiagnosed by healthcare professionals.
- People with peripheral arterial disease have a higher risk of coronary artery disease, heart attack or stroke.
- Left untreated, PAD can lead to gangrene and amputation.
View our interactive PAD library
Added risks for PAD
Other factors can increase your chances for peripheral artery disease, including:
- Your risk for peripheral artery disease increases with age.
- High blood pressure or high cholesterol puts you at risk for PAD.
- If you smoke, you have an especially high risk for PAD.
- If you have diabetes, you have an especially high risk for PAD.
If you’re at risk for peripheral artery disease or have been diagnosed with PAD, it’s worth knowing that:
- PAD is easily diagnosed in a simple, painless way.
- You can take control: Follow your doctor’s recommendations and strive to lead a heart-healthy lifestyle.
- Some cases of PAD can be managed with lifestyle changes and medication.
Atherosclerosis and PAD
If you have atherosclerosis, that means that plaque has built up inside your artery walls. Plaque is made up of deposits of fats, cholesterol and other substances. Atherosclerosis in the peripheral arteries is the most common cause of PAD.
To see how plaque limits blood flow, view our interactive PAD library.
What happens is this: First, plaque builds up enough to narrow an artery, which chokes off blood flow. Next, if that plaque becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot can further narrow the artery, or completely block it.
If that blockage remains in the peripheral arteries of the legs, it can cause pain, changes in skin color, difficulty walking and sores or ulcers. Total loss of circulation to the legs and feet can cause gangrene and the loss of a limb.
If the blockage occurs in a carotid artery, it can cause a stroke.APA Peripheral Vascular Disease Essay Paper
Watch an atherosclerosis and PAD animation
It’s important to learn the facts about PAD. As with any disease, the more you understand, the more you’ll be able to help your doctor make an early diagnosis. PAD has common symptoms, but many people with PAD never have any symptoms at all.
Effective PVD treatment aims to slow or stop disease progression, manage pain and other symptoms, and reduce the risk of serious complications.
PVD treatment plans usually involve lifestyle changes. Some people may also require medication, and severe cases may require surgical treatment.
Lifestyle changes include:
- engaging in regular exercise, including walking
- eating a balanced diet
- losing weight if necessary
- quitting smoking
Medications to treat PVD include:
- cilostazol to reduce claudication
- pentoxifylline to treat muscle pain
- clopidogrel or aspirin to stop blood clotting
Co-occurring conditions may also require medicines to keep symptoms under control. For example, some people may need:
- statins (such as atorvastatin and simvastatin) to reduce high cholesterol
- angiotensin-converting enzyme (ACE) inhibitors for hypertension
- metformin or other diabetes medications to manage blood sugar APA Peripheral Vascular Disease Essay Paper
People with severe PVD might require surgery to widen arteries or bypass blockages. Surgical options are:
- Angioplasty. This involves inserting a catheter that is fitted with a balloon into the damaged artery and then inflating the balloon to widen the artery. Sometimes, the doctor will place a small tube (stent) in the artery to keep it open.
- Vascular bypass surgery. Also known as a vascular graft, this procedure involves reconnecting blood vessels to bypass a narrow or blocked part of a vessel. It allows blood to flow more easily from one area to another.
If PVD is left undiagnosed and untreated, it can cause severe or life-threatening complications such as:
- gangrene (tissue death), which can require amputation of the affected limb
- heart attack or stroke
- severe pain that restricts mobility
- slow-healing wounds
- potentially fatal infections of the bones and blood APA Peripheral Vascular Disease Essay Paper
A person can reduce their risk of developing PVD by:
- quitting smoking, or not starting
- engaging in at least 150 minutes of cardiovascular activity, such as walking or running, each week
- eating a balanced diet
- maintaining a healthy body weight
- managing blood sugar, cholesterol, and blood pressure levels
When diagnosed early, PVD is often easily treated with lifestyle modifications and medications.
A doctor can monitor a person’s improvement by measuring the distance they can walk without claudication. If treatments are effective, people should be able to gradually walk longer distances without pain.
Early intervention may prevent the condition from progressing and can help to avoid complications. Anyone experiencing any of the symptoms of PVD should see a doctor.
The sudden development of pale, cold, and aching limbs with loss of pulses is a medical emergency and requires immediate treatment.APA Peripheral Vascular Disease Essay Paper
Atherosclerosis is the pathological process in the coronary arteries, cerebral arteries, iliac and femoral arteries, and aorta that is responsible for coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD). It begins during childhood in the intima of the large elastic and muscular arteries with deposits of lipids, principally cholesterol and its esters, in macrophages and smooth muscle cells (Figure 19-1). The lesions, called fatty streaks, produce only minimal intimal thickening and cause no disturbances in blood flow during early childhood, but they rapidly become more extensive during adolescence. In young adults, more lipid is deposited at some sites, and a core of lipid and necrotic debris becomes covered by a cap of smooth muscle and fibrous tissue. These changes produce elevated lesions called fibrous plaques that project into the lumen and begin to disturb blood flow.
The relationship between fatty streaks and fibrous plaques has been one of the most controversial aspects of the pathogenesis of atherosclerosis. The coronary arteries differ from most other arteries by having a prominent intimal layer of longitudinal smooth muscle and fibrous tissue that is apparent even in childhood. By the age of 20, the thickness of this layer is about equal to that of the media, even when it does not contain abnormal lipid (Stary, 1987a,b). This fibromuscular intimal layer occurs in all populations, even in those not predisposed to coronary atherosclerosis in adulthood (Geer et al., 1968) and is considered to be a normal anatomic structure rather than an atherosclerotic lesion.APA Peripheral Vascular Disease Essay Paper
Some evidence suggests that fibrous plaques are created by cellular proliferation and subsequent fatty degeneration without prior lipid deposition (Benditt, 1974), and some observations are not consistent with the progression of fatty streaks to fibrous plaques. For example, fatty streaks are more extensive in the thoracic aortas of children, but fibrous plaques are more extensive in the abdominal aortas of adults. Young women have more extensive fatty streaks in their coronary arteries and aortas than do young men, but among adults this pattern is reversed. (McGill, 1968).
Peripheral artery disease (PAD) is an abnormal narrowing of arteriesother than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular disease. Peripheral artery disease most commonly affects the legs, but other arteries may also be involved. The classic symptom is leg pain when walking which resolves with rest, known as intermittent claudication. Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg. Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke. Up to 50% of people with PAD do not have symptoms APA Peripheral Vascular Disease Essay Paper
The greatest risk factor for PAD is cigarette smoking. Other risk factors include diabetes, high blood pressure, kidney problems, and high blood cholesterol. The most common underlying mechanism of peripheral artery disease is atherosclerosis, especially in individuals over 40 years old. Other mechanisms include artery spasm, blood clots, trauma, fibromuscular dysplasia, and vasculitis. PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm. Duplex ultrasonography and angiography may also be used. Angiography is more accurate and allows for treatment at the same time; however, it is associated with greater risks.
It is unclear if screening for peripheral artery disease in people without symptoms is useful as it has not been properly studied. In those with intermittent claudication from PAD, stopping smoking and supervised exercise therapy improve outcomes. Medications, including statins, ACE inhibitors, and cilostazol may also help. Aspirin does not appear to help those with mild disease but is usually recommended in those with more significant disease due to the increased risk of heart attacks. Anticoagulants such as warfarin are not typically of benefit. Procedures used to treat the disease include bypass grafting, angioplasty, and atherectomy APA Peripheral Vascular Disease Essay Paper
In 2015, about 155 million people had PAD worldwide. It becomes more common with age. In the developed world, it affects about 5.3% of 45- to 50-year-olds and 18.6% of 85- to 90-year-olds. In the developing world, it affects 4.6% of people between the ages of 45 and 50 and 15% of people between the ages of 85 and 90. PAD in the developed world is equally common among men and women, though in the developing world, women are more commonly affected. In 2015 PAD resulted in about 52,500 deaths, which is an increase from the 16,000 deaths in 1990
Overall, however, evidence supports the association of fatty streaks with fibrous plaques. Lesions in the arteries of young adults have many histological and chemical characteristics of fatty streaks as well as fibrous plaques—an observation suggesting a continuous progression from one type of lesion to the other (Geer et al., 1968; Katz, 1981; Stary, 1987a,b). Furthermore, in contrast to the differences in location of fatty streaks and fibrous plaques in the aorta, the sites of fatty streaks in the coronary arteries of children are the most common sites of fibrous plaques in adults (Montenegro and Eggen, 1968). The major risk factors, hypercholesterolemia and hypertension, are closely associ-APA Peripheral Vascular Disease Essay Paper
ated with the extent of fibrous plaques in adults (Solberg and Strong, 1983). The few relevant data indicate that there is an association between serum cholesterol and low-density lipoprotein (LDL) cholesterol concentrations with fatty streaks in childhood (Freedman et al., 1988; Newman et al., 1986). Furthermore, it seems most likely that fatty streaks in children are labile, i.e., some may regress or remain as fatty streaks whereas others progress and evolve into fibrous plaques. This later process occurs particularly in the coronary arteries and abdominal aorta, where some fatty streaks are gradually converted to fibrous plaques by continued lipid deposition and reactive chronic inflammation and repair. For a review of this subject, see McGill (1988).
Regardless of their origin, fibrous plaques undergo a variety of qualitative changes in early middle age in the U.S. population, as illustrated in Figure 19-1. These changes result in fibrous plaques that vary in their content of lipids, smooth muscle cells, connective tissue, calcium, and vessels. The most serious complication is ulceration of the connective tissue and smooth muscle cap of fibrous plaque, a change that exposes blood to the lipid-rich necrotic debris of the core and is likely to precipitate thrombosis. Another serious complication is hemorrhage into the plaque. This causes sudden swelling of the plaque and may precipitate ulceration and thrombosis.APA Peripheral Vascular Disease Essay Paper
Thrombosis overlying an advanced atherosclerotic fibrous plaque is the most common event that occludes the lumen of the coronary artery and causes ischemia. At a point, determined by such factors as blood pressure, collateral circulation, and tissue oxygen demand, the blood supply is reduced below a critical level and ischemic necrosis occurs in the tissue supplied by the affected artery.
Lesions in the coronary arteries lead to CHD, which is the most common and most serious manifestation of atherosclerotic cardiovascular diseases in middle-aged adults. The atherosclerotic process that occurs in the cerebral and peripheral arteries is similar to that which occurs in the coronary arteries, but the lesions usually develop a decade or two later than those in the coronary arteries.APA Peripheral Vascular Disease Essay Paper
Peripheral vascular disease is a manifestation of systemic atherosclerosis that leads to significant narrowing of arteries distal to the arch of the aorta. The most common symptom of peripheral vascular disease is intermittent claudication. At other times, peripheral vascular disease leads to acute or critical limb ischemia. 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. Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult. The standard office-based test to determine the presence of peripheral vascular disease is calculation of the ankle-brachial index. 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. Contrast arteriography is used for definitive localization before intervention. Treatment is divided into lifestyle, medical, and surgical therapies. Lifestyle therapies focus on exercise, smoking cessation, and dietary modification. Medical therapy is directed at reducing platelet aggregation. In addition, patients with contributing disorders such as hypertension, diabetes, and hyperlipidemia need to have these conditions managed as aggressively as possible. Surgical therapies include stents, arterectomies, angioplasty, and bypass surgery.APA Peripheral Vascular Disease Essay Paper
If thrombosis forms over an atherosclerotic plaque in a cerebral artery, ischemic necrosis occurs in the brain (cerebral infarct). Cerebral infarction (one type of stroke) typically causes paralysis on the contralateral side due to lack of upper motor neuron function, and disturbances of speech, vision, hearing, and memory, depending on the anatomic location of the infarct. Death may occur due to involvement of the brain centers
controlling respiration or to cerebral edema. The necrotic tissue is converted to a liquid-filled cavity. Function is usually recovered to some degree as edema subsides, but neurons do not regenerate. Neural control of muscles and sensory organs may be regained in part as other pathways are developed. If the arterial occlusion is partial or temporary, temporary functional cerebral impairment may occur for a few minutes to a few hours (transient ischemic attacks). These episodes, which are analogous to angina pectoris, indicate that the patient has a high risk of developing cerebral infarction.APA Peripheral Vascular Disease Essay Paper
Another type of stroke is cerebral hemorrhage, which includes intracerebral hemorrhage (bleeding into the brain) and subarachnoid hemorrhage (bleeding into the space between the arachnoid membrane and the surface of the brain). In an intracerebral hemorrhage, an artery within the brain ruptures and causes a large area of tissue destruction. Its clinical manifestations are similar to those of cerebral infarction, except that it is more rapid in onset and more likely to be fatal. This type of stroke is almost always associated with severe hypertension. Since hypertension augments cerebral atherosclerosis, it is a major risk factor for both cerebral infarction and intracerebral hemorrhage.
The rupture of an artery into the subarachnoid space is usually at the site of a developmental defect in the artery wall. Either the defect, or its rupture, or both may be enhanced by hypertension. The clinical manifestations of a subarachnoid hemorrhage are similar to those of other types of stroke.APA Peripheral Vascular Disease Essay Paper
Peripheral arterial disease (PAD) occurs when atherosclerosis and its complications in the abdominal aorta, iliac arteries, and femoral arteries produce temporary arterial insufficiency in the lower extremities upon exertion (intermittent claudication) or ischemic necrosis of the extremities (gangrene). In the abdominal aorta, weakening of the media underlying the atherosclerotic plaque leads to an aneurysm, which may become filled with a thrombus or rupture into the abdominal cavity.
The major risk factors associated with clinically manifest atherosclerotic diseases also are associated with the severity of atherosclerosis. In particular, LDL cholesterol levels are positively correlated with fibrous plaques and other advanced lesions, and high-density lipoprotein (HDL) cholesterol levels are inversely associated with advanced lesions (Solberg and Strong, 1983). Hypertension is more closely associated with advanced atherosclerosis in the cerebral arteries than in other arteries, a selective effect consistent with the identification of hypertension as the dominant risk factor for stroke. Cigarette smoking is associated with advanced atherosclerosis of the abdominal aorta and iliac-femoral arteries, and consequently with PAD (DHHS, 1983). Smoking also is associated with advanced coronary atherosclerosis, but the increased coronary atherosclerosis in smokers is not sufficient to account for their much greater risk of CHD; other mechanisms, particularly thrombosis, are probably involved. Diabetes mellitus also is associated with severity of atherosclerosis in all arteries. Men have more severe coronary atherosclerosis than women, just as they have a higher frequency of CHD, but there is no sex difference in the severity of atherosclerosis of the aorta or cerebral arteries.APA Peripheral Vascular Disease Essay Paper
In populations with low serum cholesterol levels, atherosclerosis is less severe in those without hypertension and diabetes. However, among the latter, the severity of the disease is less than in populations where hyperlipidemia is prevalent (Robertson and Strong, 1968). Thus, hyperlipidemia, hypertension, and diabetes are additive in their effect on atherosclerosis, just as they are additive in their effect on risk of clinical disease. There is less information about the effects of cigarette smoking among different populations, but the evidence (Keys, 1980; Robertson et al., 1977) suggests that a similar relationship exists.
CHD risk factors for which no associations with severity of atherosclerosis have been found include physical activity and obesity (Solberg and Strong, 1983). The relationship of other putative risk factors to the severity of atherosclerosis has not been determined.APA Peripheral Vascular Disease Essay Paper
Results of animal experiments are consistent with observations in humans. LDL cholesterol and HDL cholesterol levels, and the ratio of the two lipoprotein cholesterol concentrations to one another are highly predictive of lesions in laboratory animals. High blood pressure combined with hyperlipidemia accelerates experimentally induced atherosclerosis. Despite several attempts, no effect of cigarette smoking on experimentally induced atherosclerosis has been demonstrated (Rogers et al., 1988).
The main recognized clinical presentations of PAD are intermittent claudication (IC) and critical limb ischemia (CLI). IC describes the symptoms of pain in the muscles of the lower limb brought on by physical activity which is rapidly relieved by rest. CLI is a more severe manifestation of PAD, which presents as rest pain, ischemic ulceration or gangrene of the foot. Patients with CLI have a high risk of limb loss and fatal or non-fatal vascular events, such as myocardial infarction (MI) and stroke . Acute limb ischemia (ALI) occurs when there is a sudden interruption of blood flow to a limb typically due to an embolism or thrombosis . In contrast to CLI, which typically develops over a prolonged period often preceded by IC, patients with ALI may not have preceding symptoms. ALI usually threatens limb viability more urgently than CLI possibly due to the absence of an established collateral blood supply to the limb.APA Peripheral Vascular Disease Essay Paper
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