Thanks for joining me
on this discussion of peripheral vascular disease
in the section of vascular surgery.
Let's start this discussion
with risk factors for peripheral vascular disease.
In this lecture module,
we’ll focus on peripheral
arterial occlusive disease.
As you know,
with any arterial disease,
including coronary artery disease,
smoking continues to
be a very big risk factor.
There seems to be a male preponderance
and diabetes is associated with this.
As we age,
male patients tend to increase their likelihood
of getting peripheral vascular disease.
And as I previously mentioned,
there is a high correlation
between coronary artery disease
and other atherosclerotic disease
and peripheral arterial occlusive disease.
There's also indication that high blood pressure,
particularly chronic high blood pressure,
and family history may play
a role in this disease process.
As you know from the risk factors,
some of those risk factors are modifiable,
others not so much.
Let’s take a quick look at the normal anatomy.
Take a look at this image on the screen.
On the left side of the screen,
you notice a widely patent vessel.
This vessel allows for linear or laminar flow.
Now compare it to the vessel
on the right side of the screen.
Notice the yellow plaque.
As that plaque continues to develop,
the lumen of the vessel narrows.
As we've discussed in previous modules,
as the vessel lumen narrows,
the velocity increases.
there's also a significant pressure
drop across this narrowing.
We’ll come back to this concept later.
atherosclerotic plaques narrow the
lumen and decrease flow to the extremities.
We think of peripheral arterial occlusive disease
as a multifactorial development.
What do we mean by this?
There seems to be some genetic component,
although we can't quite put our fingers on it.
However, there seems to be
a preponderance of peripheral arterial
occlusive disease that run in the family.
Additionally, inflammatory mediators.
Remember that slide with the plaque,
as fat is deposited along the vessel,
vessel injury occurs.
As a result of local injury,
are summoned to the area
and can cause further damage.
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.