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Vascular Diseases
Mustika Mahbubi MD
 PAD (Peripheral artery
disease)
• is a common circulatory
problem in which narrowed
arteries reduce blood flow to
your limbs.
• When you develop peripheral
artery disease (PAD), your
extremities — usually your legs
— don't receive enough blood
flow to keep up with demand.
This causes symptoms, most
notably leg pain when walking
(claudication)
 Symtomps
• Painful cramping in one or both of your hips, thighs or
calf muscles after certain activities, such as walking
or climbing stairs (claudication)
• Leg numbness or weakness
• Coldness in your lower leg or foot, especially when
compared with the other side
• Sores on your toes, feet or legs that won't heal
• A change in the color of your legs
• Hair loss or slower hair growth on your feet and legs
• Slower growth of your toenails
• Shiny skin on your legs
• No pulse or a weak pulse in your legs or feet
• Erectile dysfunction in men
 causes
• same as those for atherosclerosis
• PAD is two times as common in males as females
- Smoking
- DM
- Dyslipidemia
- HT
- obesity
- Others (inflammatory mediators, genetics)
 Diagnosis
• History and physical
exam
• Ankle – brachial
index (ABI)
• DUS (doppler
Ultraosund)
• Angiography
• Other (CT and MRA)
 Complications
• Critical Limb Ischemia
• Stroke and Heart attack
 Treatment
• Lifestyle (stop smoking, regular exercise 35-50 minutes, 3-4 times/week)
• Medication risk factor
• Antiplatelet
• Statin
• Cilostazol  improve symtoms
• Revascularitation
ALI/CLI
ALI/ CLI (Limb Ischemia)
• Acute limb ischaemia (ALI) occurs
when there is a sudden lack of blood
flow to a limb
• Acute limb ischaemia is caused by
embolism or thrombosis, or rarely by
dissection or trauma. Thrombosis is
usually caused by PAD. while an
embolism is usually of cardiac origin
• In contrast to acute limb ischemia,CLI
results from PAD that develops over
time
 When a limb is ischemic in the non-acute (chronic) setting,
the condition is alternatively called PAD or CLI

Symtomps ALI
• Pain
• Pallor (pale appearance of the limb)
• Paresthesias (abnormal sensations in
the limb)
• Perishingly cold CLI
• Pulselessness - Rest pain
• Paralysis is a continuous burning pain of the lower leg. It begins,
or is aggravated, after reclining or elevating the limb and
is relieved by sitting or standing. It is more severe than
These symptoms are called "the six P's'" intermittent claudication

- Tissue lost
Tissue loss is the development of
arterial insufficiency ulcers or gangrene due to
peripheral artery disease
Causes
 Diagnosis
• History and physical
exam
• Ankle – brachial
index (ABI)
• DUS (doppler
Ultraosund)
• Angiography
• Other (CT and MRA)
 Treatment
• Life style modification
• Control risk factors
• Medical treatment : vasodilator,
pentoxifylin, antiplatelet,
antikoagulan, statin, analgesic
• Surgical management: angioplasty,
stenting, endartrectomy, arterial
bypass, amputation
CVI
 CVI
• Occurs when the vein valves become dysfunctional and impairs venous
blood return.

• Venous blood escapes from its normal antegard path of flow and refluxes
backward down the veins into an already

• Affects up to 5- 15% of adults.

• By age 50 ~40% of women and 20% of men have significant vein

problems.

• More people lose work time from vein disorders then from artery disease. 1.
• Veins:
• Hold 75% of the blood
volume
• Are organized into
superficial and deep veins
connected by perforating
veins
• Have valves for
unidirectional flow
• Are low pressure systems
(10-15mmHg)
• Have thin walls (superficial
veins have thicker walls than
deep veins.)
 Anatomy
The venous network in the lower extremities
commonly affected by CVI is divided into the
following 3 systems:
• Superficial veins (including the great
saphenous vein [GSV], the small saphenous
vein [SSV], and their tributaries)
• Deep veins (including the anterior tibial,
posterior tibial, peroneal, popliteal, deep
femoral, superficial femoral, and iliac veins)
• Perforating or communicating veins
 Symptoms and Signs

• Nocturnal pain, restless legs

• Orthostatic pain, burning swelling, leg fatigue
• Edema, Varicosity, Hyperpigmentation, ulceration,
chronic cellulitis, venous dermatitis
 CLASSIFICATION VEIN DISEASE
 CEAP – an international consensus conference initiated the Clinical-Etiology-Anatomy-Pathophysiology classification.
 C 0 – no evidence of venous disease.
 C 1 – telangiectasias/reticular veins.
 C 2 – varicose veins.
 C 3 – edema associated with vein disease.
 C 4a – pigmentation or eczema.
 C 4b – lipodermatosclerosis.
 C 5 – healed venous ulcer.
 C 6 – active venous ulcer.
 E c – congenital
 E p – primary venous disease.
 E s – secondary venous disorder.
 E n – not specified.
 A s – superficial veins.
 A d – deep veins.
 A p – perforating veins.
 A n – not specified.
 P r – venous reflux.
 P o – venous obstruction.
 P n – not specified. 7.
DUS examination
Patient doppler
• Supine position and standing position
compression and valsalva manuever
• Reflux defined as reverse flow > 500 msec,
recent study reflux cutoff value in
femoropopliteal veins > 1000 ms
• Colour flow display  A competent vein will
display a burst of flow toward the heart during
a calf squeeze. Significant venous reflux will
be demonstrated by a sustained period of
retrograde flow following calf release

Superficial veins, deep femoral veins, and deep

calf veins, reflux is greater than 500 ms
perforating veins, reflux is greater than 350 ms
common femoral, femoral, and popliteal veins,
reflux is greater than 1000 ms
MANAGEMENT OF CVI –
COMPRESSION STOCKINGS
 MANAGEMENT OF CVI -
MEDICATIONS
 Diuretics – one of the most inappropriate treatments.
 Aspirin – may accelerate the healing of chronic ulcers.
 Pentoxifylline – more effective for complete or partial ulcer
healing then placebo.
 Stanozolol – an anabolic steroid that stimulates fibrinolysis
and improves lipodermatosclerosis and possibly ulcer healing.
 Escin (horseshoe chestnut) – 50mg twice daily reduces leg
volume and edema. It stimulates the release of F series
prostaglandins which induce venoconstriction, decreasing the
permeability of vessel walls to low molecular proteins, water,
and electrolytes.
DVT
• Deep vein
DVT
thrombosis (DVT) is
the formation of a
blood clot in a deep
vein, most commonly
in the legs or pelvis
Sign and symtomps
causes
Complication
Diagnosis
Management
MANAGEMENT OF CVI –
COMPRESSION STOCKINGS
 OTHER TREATMENT
• Surgical management – when anticoagulant therapy is ineffective
• Inferior vena cava filter – vascular filter to prevent pulmonary emboli
• Exercising lower legs muscle to improve circulation of blood in legs