3. Peripheral Vascular Disease

Peripheral Vascular Disease (PVD) is an umbrella term for disorders affecting blood vessels outside the heart and brain. It includes both:

  • Arterial pathology – e.g. Peripheral Arterial Disease (PAD)

  • Venous pathology – e.g. Chronic Venous Insufficiency (CVI), varicose veins

  • Lymphatic dysfunction – e.g. lymphoedema

🛡️ Risk Factors – Mnemonic: VENOUS

  • Venous thrombosis (e.g. DVT)

  • Estrogen – pregnancy or OCP

  • Non-mobile (sedentary lifestyle, standing jobs)

  • Obesity

  • Uncommon congenital anomalies

  • Smoking

📋 Clinical Features – Mnemonic: TROPHY

  • Telangiectasia / tortuous veins (varicosities)

  • Restless or heavy legs

  • Oedema (especially evening)

  • Pigmentation (haemosiderin)

  • Haemosiderin staining / skin changes

  • Yielding of skin → ulcers (typically medial malleolus)

🔍 Peripheral Vascular Disease – Investigations Summary

Subtype🥇 1st-Line Investigations🥈 2nd-Line / Specialist Investigations
Peripheral Arterial Disease (PAD)– ABPI (Ankle-Brachial Pressure Index)
– Duplex Doppler USS		– CT or MR Angiography
– Bloods: FBC, U&Es, Lipids, HbA1c
– ECG
Chronic Venous Insufficiency / Varicose Veins– Clinical exam
– Duplex Doppler USS		– Venous plethysmography (rare)
– D-dimer if DVT suspected
Lymphatic Disorders– Clinical exam
– Limb circumference comparison		– Lymphoscintigraphy
– MRI/CT (to rule out secondary causes)

Peripheral Vascular Disease – Management Summary

Subtype🔧 Conservative / Lifestyle💊 Medical Management🏥 Procedural / Surgical
Peripheral Arterial Disease (PAD)– Smoking cessation
– Supervised exercise
– Foot care		– Clopidogrel (1st-line antiplatelet)
– Statins
– BP & diabetes control		– Angioplasty +/- stent
– Surgical bypass (for CLI)
Chronic Venous Insufficiency / Varicose Veins– Leg elevation
– Compression stockings
– Avoid prolonged standing		– Venoactive drugs (e.g. flavonoids – limited evidence)– Endovenous laser therapy
– Foam sclerotherapy
– Surgical stripping
Lymphatic Disorders– Compression garments
– Skin care
– Manual lymphatic drainage		– Diuretics (only if concurrent oedema or heart failure)– Lymphatic bypass surgery (rare)
– Debulking procedures (severe cases)

⚠️ Complications

  • Recurrent cellulitis

  • Skin thickening, disfigurement

  • Functional impairment

🔺 Last updated in line with NICE CG147 – Peripheral arterial disease: diagnosis and management NICE NG89 – Chronic lower limb venous disease: diagnosis and management and BMJ Best Practice – Lymphoedema

Published: August 2012 • Last updated: October 2020 (PAD) | July 2021 (CVI)
Last reviewed: August 2025
✅ PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.

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