Does PVD include both PAD and CVI?

Peripheral vascular disease (PVD) involves circulatory problems that can be due to EITHER arterial or venous pathology.

The signs, symptoms, and treatment of PVD can be opposite, depending on the source of the pathology. Therefore, careful assessment is VERY important.

Predisposing Factors:

• Arterial: Atherosclerosis (95% of all cases are caused by atherosclerosis), advanced age
  
• Venous: Hx of DVT, valvular incompetence
  

Associated Diseases:

• Arterial
  
  • Raynaud's disease (nonatherosclerotic, triggered by extreme heat/cold, spasms of arteries)
    
    
  • Buerger disease (occlusive inflammatory disease, strongly associated with smoking)
    
    
  • Diabetes
    
    
  • Acute occlusion (emboli/thrombi)
    
    

  [*]Venous

  • Varicose veins
    
    
  • Thrombophlebitis
    
    
  • Venous stasis ulcers
    
    

Skin

• Arterial: Smooth, shiny, loss of hair, thick nails
  
• Venous: Brown pigment around ankles
  

Color

• Arterial: Pallor on ELEVATION, rubor when DEPENDENT
  
• Venous: Cyanotic when DEPENDENT
  

Temperature

• Arterial: Cool
  
• Venous: Warm
  

Pulses

• Arterial: Decreased or absent
  
• Venous: Normal
  

Pain

• Arterial
  
  • Sharp
    
    
  • Increase with walking and elevation
    
    
  • Intermittent claudication (
    CLASSIC
    presenting symptom, occurs in skeletal muscles during exercise; relieved by rest)
    
    
  • Rest Pain (occurs when extremities are horizontal; may be relieved by dependent position; often appears when collateral circulation fails to develop)
    
    

  [*]Venous

  • Persistent, aching, full feeling, dull sensation
    
    
  • Pain relieved when horizontal (
    ELEVATED EXTREMITIES
    and use elastic stockings)
    
    
  • Nocturnal cramps
    
    

Ulcers

• Arterial
  
  • Client may describe as very painful
    
    
  • Occur on lateral lower leg, toes, heel
    
    
  • Demarcated edges
    
    
  • Small, but deep
    
    
  • Circular in shape
    
    
  • Necrotic
    
    
  • Not edematous
    
    

  [*]Venous

  • Described by client as dull ache or heaviness
    
    
  • Occur on medial leg, ankle
    
    
  • Uneven edges
    
    
  • Superficial, but large
    
    
  • Marked by edema
    
    
  • Highly exudative
    
    

Treatment

Arterial: Bed rest/immobilization

Venous: Limb elevation

Nursing

Encourage rest at first sign of pain

Encourage keeping extremities elevated (if venous) when sitting, and change position often

Hope this helps!