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.