Definition

Peripheral vascular disease (PVD) is an inflammatory disease of the peripheral vasculature. As the lumen of the vessel decreases in diameter, increases in resistance to blood flow occur. As a result of this process, perfusion to peripheral or central tissue is decreased, which can lead to ischemia and cellular necrosis.

Etiology

Peripheral vascular disease may manifest as systemic vasculitis or arterial occlusive disease. There are several types of PVD.

Anesthetic considerations

Corticosteroid supplementation may be necessary for patients already treated with these drugs. These patients also may be taking anticoagulants; therefore, regional anesthesia may be controversial. Blood pressure may be difficult to measure noninvasively in the upper extremities, so an arterial line may be necessary. Preoperatively, it is wise to evaluate range of motion of the cervical spine because hyperextension of the head during laryngoscopy may compromise cerebral blood flow (the carotid arteries are shortened as a result of the vascular inflammatory process). Finally, a major anesthetic goal intraoperatively is maintenance of adequate perfusion pressure.

Definition

Thromboangiitis obliterans is an inflammatory process of the wall and connective tissue surrounding the arteries and veins, especially in the extremities. It is often associated with the thrombosis and occlusion that commonly result in gangrene. Jewish men between the ages of 20 and 40 years seem to have a higher incidence of this disease.