Peripheral Vascular Disease (PVD): Etiology

00:01 Welcome back.

00:02 Thanks for joining me on this discussion of peripheral vascular disease in the section of vascular surgery.

00:09 Let's start this discussion with risk factors for peripheral vascular disease.

00:15 In this lecture module, we’ll focus on peripheral arterial occlusive disease.

00:20 As you know, with any arterial disease, including coronary artery disease, smoking continues to be a very big risk factor.

00:29 There seems to be a male preponderance and diabetes is associated with this.

00:35 As we age, male patients tend to increase their likelihood of getting peripheral vascular disease.

00:42 And as I previously mentioned, there is a high correlation between coronary artery disease and other atherosclerotic disease and peripheral arterial occlusive disease.

00:52 There's also indication that high blood pressure, particularly chronic high blood pressure, and family history may play a role in this disease process.

01:04 As you know from the risk factors, some of those risk factors are modifiable, others not so much.

01:10 Let’s take a quick look at the normal anatomy.

01:13 Take a look at this image on the screen.

01:15 On the left side of the screen, you notice a widely patent vessel.

01:20 This vessel allows for linear or laminar flow.

01:24 Now compare it to the vessel on the right side of the screen.

01:27 Notice the yellow plaque.

01:29 As that plaque continues to develop, the lumen of the vessel narrows.

01:34 As we've discussed in previous modules, as the vessel lumen narrows, the velocity increases.

01:40 Unfortunately, there's also a significant pressure drop across this narrowing.

01:45 We’ll come back to this concept later.

01:47 Remember, atherosclerotic plaques narrow the lumen and decrease flow to the extremities.

01:53 We think of peripheral arterial occlusive disease as a multifactorial development.

01:59 What do we mean by this? There seems to be some genetic component, although we can't quite put our fingers on it.

02:06 However, there seems to be a preponderance of peripheral arterial occlusive disease that run in the family.

02:15 Additionally, inflammatory mediators.

02:18 Remember that slide with the plaque, as fat is deposited along the vessel, vessel injury occurs.

02:25 As a result of local injury, inflammatory mediators are summoned to the area and can cause further damage.

02:33 And lastly, there's evidence that biomechanical stresses on the arterial wall, particularly in chronic nature, can contribute to this disease process, namely chronic high blood pressure.