Prevention of PVD
In Conditions Diagnosed with Lower Extremity Ultrasound
- Peripheral venous disease (PVD: thrombus, thrombophlebitis, and emboli; venous stasis, insufficiency, and ulceration)
- Peripheral arterial disease (PAD: claudication, obstruction, ischemia)
Their prevention is as important as treating their underlying conditions.
Peripheral Venous Disease (PVD)
Venous valves deteriorate with age and become incompetent. Prevention of age-related PVD is based on counteracting this with continued activity of the lower extremity, including exercise and ambulation, in order to keep the “secondary pump” action of the leg musculature functioning to move blood back up toward the heart. Compression stockings, leg elevation, and avoiding trauma to the legs are important. Smoking cessation and weight management improve PVD and prevent further progression.
Complications of PVD include acute and chronic ulcerations, local infection, sepsis, and deep vein thrombosis (DVT) and pulmonary emboli. Diagnosis is based on clinical signs and symptoms and ultrasound. Any ulceration should be aggressively managed to eliminate risk to contiguous tissues or systemic spread of infection.
Risks for both PVD and DVT include immobilization, lengthy convalescence, or prolonged hospitalization; age >65 years, obesity, previous thrombosis or thromboembolism, malignancy, family history of venous thrombosis, autoimmune disease and inflammatory bowel disease, smoking, previous trauma to the leg(s), and–in women–the high estrogenic state that results from pregnancy, oral contraceptives, or menopausal hormone replacement.
Peripheral Arterial Disease
Risks for Arterial Disease are atherosclerosis, arteritis, smoking, obesity, diabetes, high cholesterol, and hypertension.
Hypertension and cardiovascular arterial disease are managed/prevented by the use of antihypertensive medications, smoking cessation, avoidance of hyperglycemia (especially in diabetics), and weight management to improve the comorbidity of metabolic syndrome. Exercise is important in preventing further progression and in reducing the PAD and/or the hypertension responsible for plaque formation and arterial blood flow compromise due to narrowing or occlusion.