Management and Treatment of Peripheral Venous Disease (PVD)
PVD includes thrombophlebitis and thrombosis (deep vein thrombosis–DVT) and venous stasis due to the impairment of the venous valves (venous insufficiency).
For DVT, whether to offer anticoagulation therapy is based on a risk assessment, but when warranted uses agents such as warfarin, clopidogrel (Plavix), etc., to discourage further thrombosis as well as dissolve current clots. The complication of DVT that is life-threatening is pulmonary embolism, which makes DVT a serious condition warranting early diagnosis and treatment.
For venous insufficiency and varicosities, leg elevation, compression stockings, ambulation and exercise, and–for diabetics–strict glycemic control are used to mitigate painful and cosmetic issues and increase oxygen transport to the skin. If venous insufficiency progresses to venous ulceration, ulcer wound management, compression, and bandaging systems are used. Vein excision and ablation may be necessary. If there is any infection to the overlying skin or associated with ulceration, this is cultured and treated with antibiotics accordingly.
Management of Peripheral Arterial Disease (PAD)
PAD includes the symptoms of claudication and paresthesias (numbness or tingling), as well as signs of ischemia and necrosis. Most at risk are the terminal branches of the arterial tree–the distal fingers and toes, but in the leg signs and symptoms can range from the iliac arteries to the tibial vessels.
Any plaque build-up due to atherosclerosis can result in partial or complete obstruction, requiring surgical correction to re-establish blood flow. More conservative measures are smoking cessation, diet and nutrition, and supervised exercise.