Description

Peripheral vascular disease (PVD) is one of the serious manifestations of atherosclerosis and yet is often undertreated. It commonly presents as intermittent claudication (IC) but can be quiescent or present atypically in the older person. Critical ischaemia of the lower limb is the more serious end of the spectrum. Risk factors are similar to those of coronary disease. The prevalence of PVD increases with advancing age affecting 30-50% of those aged 85 and above. Regardless of whether PVD is symptomatic or not these patients have a higher mortality rate than healthy controls. This is related to the pervasive nature of atherosclerosis placing patients at risk of death due to coronary heart disease, cerebrovascular disease and abdominal vascular disease. The ankle brachial pressure index (ABPI) is a simple and useful initial test for the detection of PVD. An ABPI of <0.9 is consistent with a diagnosis of PVD. The aims of therapy are to relieve symptoms; improve functional capacity; prevent the disease from progressing further and halt the risk of vascular complications such as myocardial infarction. Treatment will vary according to the presentation of the disease. The mainstays of treatment for IC are risk factor modification, supervised exercise and angioplasty. In critical lower limb ischaemia management focuses on limb salvage and may vary from surgical revascularisation (including endarterectomy, bypass grafting and amputation) to palliative measures. PVD is a serious diagnosis and, along with its risk factors, should be treated aggressively to prevent disease progression and vascular complications.