Lecture on Peripheral Arterial Disease vs. Peripheral Venous Disease

Introduction

• Focus on distinguishing peripheral arterial disease (PAD) from peripheral venous disease (PVD).
• Key to understanding: how patients present with each condition.
• Mnemonic: VESSEL to remember differences in assessment.

V: Various Positions

• Arterial Disease:
  • Preferred position: Legs dangled down.
  • Cause: Blood flow issues to extremities → ischemia.
  • Dangling helps blood reach extremities; elevating worsens pain.
• Venous Disease:
  • Preferred position: Legs elevated.
  • Cause: Problem with blood returning to the heart.
  • Elevation decreases swelling; dangling or prolonged standing worsens pain and swelling.

E: Explanation of Pain

• Arterial Disease:
  • Pain is sharp, worse at night (rest pain).
  • Intermittent claudication: severe cramping, tingling in legs during activity, relieved by rest.
  • Cause: Oxygen deprivation in muscles due to poor blood flow.
• Venous Disease:
  • Pain is heavy, dull, throbbing, and aching.
  • Worsens with standing or sitting with legs down.
  • Elevation eases pain and swelling.

S: Skin of Lower Extremity

• Arterial Disease:
  • Poor perfusion → cool, thin, dry, scaly skin.
  • Hairless with thick toenails.
  • Color changes: Red and warm when dangled (rubor); pale when elevated.
• Venous Disease:
  • Good perfusion but poor drainage.
  • Warm, thick, tough, edematous skin with a brownish color.

S: Strength of Pulse

• Arterial Disease:
  • Compromised circulation → poor or absent pulse.
  • Use Doppler to assess pulse.
• Venous Disease:
  • Normal pulse present.

E: Edema

• Arterial Disease:
  • Edema not common.
• Venous Disease:
  • Common, worsens by the end of the day.

L: Lesions (Ulcers)

• Arterial Ulcers:
  • Locations: Ends of toes, dorsum of feet, lateral malleolus.
  • Appearance: Little drainage, pale or necrotic, punched out look.
  • Deep, round with defined edges.
• Venous Ulcers (Venous Stasis Ulcers):
  • Locations: Medial lower legs, medial malleolus.
  • Appearance: Swollen, edematous, with drainage.
  • Base is pink to deep red, irregular edges, shallow depth.

Conclusion

• Summary of differences between arterial and venous diseases.
• Importance of recognizing clinical features for diagnosis.