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Peripheral vascular disease (PVD) is a chronic limb ischemic disease, and vascular diseases other than cardiovascular and cerebrovascular diseases are collectively referred to as peripheral vascular diseases. Peripheral vascular disease includes diseases of the arterial, venous and lymphatic systems.

Peripheral vascular disease (PVD) is a chronic limb ischemic disease, and vascular diseases other than cardiovascular and cerebrovascular diseases are collectively referred to as peripheral vascular diseases. Peripheral vascular disease includes diseases of the arterial, venous and lymphatic systems.

Chinese name

Peripheral vascular disease

Foreign name

Peripheral vascular disease, PVD

Causes of peripheral vascular disease and common diseases

Common arterial diseases include: atherosclerotic plaques and arterial stenosis due to thrombosis, such as atherosclerotic occlusive disease, arterial embolism; arterial inflammation, such as polyarteritis, thromboangiitis, nodular arteritis Arterial dilatation, such as aneurysms; Peripheral artery dysfunction, such as Raynaud's disease (phenomenon), erythematous limb pain; External pressure disorders, such as thoracic exit syndrome, iliac artery compression syndrome; Diabetic vascular disease , Arteriovenous inflammation, etc.

Venous disease is divided into superficial venous disease and deep venous disease. Superficial venous disease includes varicose veins and thrombophlebitis. Deep vein disease includes deep vein thrombosis, primary deep vein valve insufficiency, and deep vein thrombosis can cause pulmonary embolism. 2, secondary deep vein thrombosis syndrome; also includes Bugatti disease, KT syndrome and so on.

Lymphatic system diseases are mainly inflammation and obstructive reflux diseases, such as lymphangitis, erysipelas, and lymphoma.

PVD increases the risk of diabetic foot (DF). Diabetic foot is also a complication of diarrhea and death. WHO defines diabetic foot as lower extremity infection caused by diabetic patients with neuropathy and various degrees of peripheral vascular disease. , Ulcer formation and / or destruction of deep tissues. PVD is the most important influencing factor for the prognosis of diabetic foot and the main risk factor for amputation.

Peripheral vascular disease is a common and prone complication of diabetes. The pathological change of this symptom is mainly atherosclerosis. The clinical manifestations of patients are mainly the destruction of the elastic layer and muscular layer of the arterial wall and the decrease of the elasticity of the tube wall. The walls are more fragile or thickened and hardened. When the patient's blood glucose level rises, sugar will combine the hemoglobin in the blood cells, which will cause the patient's whole body tissues to be hypoxic. At this time, the aggregation of platelets will increase, and the viscosity will increase, which will easily form blood clots and endanger life.

Differential diagnosis of peripheral vascular disease

These diseases have complex and diverse clinical symptoms. Common symptoms include pain, soreness, numbness, edema, ulcers, and even gangrene.

The ankle-brachial index (ABI) is a diagnostic and screening criterion for diabetic vascular lesions; lower limb hemodynamics can better reflect patients' lower limb vascular structure and functional status. D-dimer can better reflect patients 'secondary fibrous reinforcement, and it is also an indicator of patients' coagulation and fibrinolysis.

Peripheral vascular disease examination

At present, the main methods for clinical examination of peripheral vascular lesions include: (1) palpation of arterial pulses such as the dorsal foot artery and the posterior tibial artery are weakened or disappeared. (2) Ankle brachial index (ABI) measurement: ABI is the ratio of ankle systolic blood pressure to brachial systolic blood pressure. ABI <0.9 indicates the possibility of arterial occlusion; ABI <0.8 indicates a high possibility of arterial occlusion; 0.5 <ABI <0.8 indicates that there is a Arterial occlusion exists; ABI 0.3 indicates vascular calcification. (3) TcPO ₂ was measured by transdermal partial pressure of oxygen, and the value of TcPO _{2 was} less than 40 mmHg, suggesting ischemia. (4) Various vascular function and structural examinations, including: blood flow-mediated vasodilation (FMD), digital subtraction angiography (DSA), multi-slice spiral CT3D angiography (3D-CTA), magnetic resonance angiography (MRA) and high frequency color Doppler (HCDU).

Peripheral vascular disease treatment principles

The indications for Chinese and western medicine treatment are acute thrombosis or embolism, chronic insufficiency of blood supply and arterial spasm diseases, including drugs such as thrombolysis, anticoagulation, depolymerization, tube expansion, defibration, and inhibition of platelet adhesion and aggregation. Commonly used western medicines include urokinase, heparin, low-molecular dextrose, pentoxifylline, thrombin, prostaglandin E, aspirin, and acrylic.

Surgical treatment is an important part of the treatment of peripheral vascular diseases, including vascular anastomosis and repair of peripheral vascular injury, vascular bypass surgery, venous valve repair and amputation. In combination with drugs, it can be used for To shorten the course of treatment, improve efficacy, reduce disability and mortality. However, surgical treatment has problems such as narrow indications, surgical complications, and a restenosis rate of up to 30% after surgery.

Interventional vascular therapy is a new type of treatment method that has been carried out for more than a decade. It has made great changes in the diagnosis and treatment of vascular surgical diseases. Compared with traditional surgery, interventional surgery has the advantages of less damage, lower complications and mortality, and faster patient recovery. Percutaneous transluminal balloon catheter angioplasty (PTA), endovascular stent implantation, atherosclerotic plaque rotation, laser angioplasty, vascular embolization, etc., are now widely used in arterial dilatation, arteries Treatment of obstructive diseases, arteriovenitis and some venous diseases. However, interventional therapy also has problems such as high cost and postoperative restenosis.