Peripheral Vascular Disease (PVD): Etiology

by Kevin Pei, MD

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    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.

    About the Lecture

    The lecture Peripheral Vascular Disease (PVD): Etiology by Kevin Pei, MD is from the course Special Surgery.

    Included Quiz Questions

    1. Low levels of homocysteine
    2. Smoking
    3. Diabetes
    4. Family history
    5. Coronary artery disease
    1. Atherosclerotic plaques narrow arterial lumens and decrease flow to the extremities
    2. Atherosclerotic plaques narrow venous lumens and decrease flow to the extremities
    3. Atherosclerotic plaques narrow lymphatic channels and decrease flow from the extremities
    4. Thrombi form in arterial lumens and decrease flow to the extremities
    5. Thrombi form in venous lumens and decrease flow to the extremities

    Author of lecture Peripheral Vascular Disease (PVD): Etiology

     Kevin Pei, MD

    Kevin Pei, MD

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