Peripheral vascular disease (PVD) is arterial disease that may lead to limb ischaemia.

Pathophysiology

The normal resting oxygen demand in the lower limb is 130–150 mL/min. In symptomatic PVD, there is an imbalance between limb perfusion supply and demand. During exercise the increased metabolic demand by muscle cannot be met, leading to anaerobic metabolism and by-product formation (e.g. lactate) causing ‘cramp-like’ pain.

In critical disease, even the resting oxygen demand cannot be met and tissue necrosis ensues. Perfusion pressures are severely reduced (<50 mmHg tibial pressure [<30 mmHg toe pressure]).

Aetiology

• Atherosclerosis (>95%).
  
• Rare causes (<5%):
  
  
  
  • Cystic adventitial disease.
    
  • Popliteal entrapment syndrome.
    
  • Persistent sciatic artery.
    
  • Fibromuscular dysplasia.
    
  • Buerger’s disease.

Epidemiology

PVD affects ∼10% of the general population and predominantly affects smokers and/or people with diabetes with a male preponderance. It is also an independent surrogate marker for both coronary and carotid artery disease (i.e. systemic atherosclerosis).