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)
- PARA-aligned, reviewed February 2026
✅ PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.
Educational platform. Not medical advice.