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Peripheral Vascular Disease
Circulation disorders includes a large number
of different problems with one thing in common, they result in poor
blood flow. Specifically, the term peripheral vascular disease refers
to blood flow impairment into the feet and legs (although it could
include the arms and hands as well). Blood is
circulated throughout the human body by the strong, muscular pump
called the heart. With each heartbeat, blood is pushed along through
blood vessels called arteries that carry the oxygen and nutrient rich
blood to all parts of the body including the legs and the feet. The
individual cells in the body take up the oxygen and nutrients. Then a
second set of blood vessels known as veins carry the oxygen depleted
blood back to the heart and lungs to get more oxygen, and again be
pumped throughout the body. Peripheral vascular disease may refer to
arterial inflow disorders, (arterial insufficiency) or venous outflow disorders (venous insufficiency). Arterial Insufficiency Arterial
inflow disorders are categorized by the size of the artery involved. If
a large artery in the thigh or behind the knee becomes blocked by
cholesterol deposits this is referred to as large vessel disease or atherosclerosis. The result may be a painful ischemic foot,
which means there is a severe lack of arterial blood flow from the
heart into the foot. If smaller arteries like those in the lower leg or
foot is blocked, this is referred to as small vessel disease, or arteriosclerosis.
This too can result in ischemia of the foot. Small vessel disease is
seen more often in diabetics, but can affect non-diabetics as well. If
the skin of the feet or legs lacks adequate blood flow a sore will
develop which may be difficult to heal. These sores are known as ischemic ulcers.
Any blockage to arterial inflow will result in a circulation problem to
the body tissues down stream. Occasionally a small blockage will occur
in the small arteries that supply blood to a toe. This is known as a "Blue Toe Syndrome."
Another arterial inflow problem may result when the smooth muscles that
control the size of the arteries go into spasm. The arterial muscle
spasm can block the blood from circulating into the foot. One common
vasospastic disorder is called Raynaud's Syndrome. A second vasospastic disorder is called acrocyanosis. Venous Insufficiency Venous
outflow disorders refer to problems getting blood from the foot back to
the heart. There are two sets of veins in the feet and legs to help
bring the blood back toward the heart. The superficial venous network
refers to veins located just beneath the skin. The deep venous networks
are veins located closer to the bones and are not visible when looking
at the foot or legs. Varicose veins
refer to an enlargement of the veins and a loss in the ability of the
vein to properly maintain blood flow back toward the heart. When this
occurs blood can collect in the feet and legs. Superficial varicose
veins may appear as unsightly cords or a small bunch of grapes, which
usually appear on the tops of the feet, around the ankles and may
extend upward to the knees and thighs. Deep varicose veins while
usually not visible will result in chronic swelling of the feet, ankles
and legs. When the blood is not circulated from the feet back to the
heart gravity will cause the fluid to collect in the feet and ankles.
This results in swelling, called edema. Chronic edema over a
long period of time may cause a discoloration of the skin around the
ankles. The skin can become inflamed, and is know as venous stasis dermatitis. If left untreated the skin will become weakened and a weeping sore will develop, usually on the inside of the ankle called a venous stasis ulcer. A
potentially serious consequence of blood collecting in the feet and
legs is the formation of blood clots in the veins. A superficial vein
blood clot will result in a painful, inflamed superficial vein called superficial phlebitis. When a blood clot forms in a deep vein, it is called deep venous thrombosis, or deep phlebitis.
This is a serious condition that causes painful swelling of the leg and
may result in part of the clot breaking free. If the clot should travel
back up to the heart and get caught in the lungs, it is referred to as
a pulmonary embolus which can be life threatening and requires emergency treatment.
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