Section 6:
Peripheral Vascular Diseases

Peripheral vascular disease (PVD) is a circulatory disorder involving any of the blood vessels outside the heart. Diseases of the lymph vessels are included in this classification. There are two types of PVDs: functional and organic. Functional PVDs are not due to organic causes and do not involve defects in the structure of the blood vessels. The effects are short-term. Raynaud's Disease is an example of a functional PVD. With Raynaud's Disease, exposure to cold or emotional stimulation results in intermittent attacks of pallor or cyanosis of the digits. In contrast to functional PVDs, organic PVDs are caused by structural changes, such as inflammation and tissue damage in the blood vessels (e.g., Buerger's disease). Buerger's disease is characterized by acute inflammatory lesions and occlusive thrombosis of the arteries and veins.

A summary of the current fitness-to-drive guidelines (Peripheral Vascular Diseases) for medical practitioners from Australia (1998) and Canada (2000) is presented in Table 14.

Prevalence

The prevalence of PVD is most commonly found in individuals 55 years of age and older, but prevalence increases with age (Hiatt and Regensteiner, 1990). For example, the prevalence of peripheral arterial disease in a population of retirees was 12 percent for those with an average age of 66, with an increase to 20 percent in those 75 and older (Criqui, Fronek, Barrett-Connor, et al., 1985).

Peripheral Vascular Diseases and Driving Literature Review

In essence, all PVDs are characterized by disturbances in blood flow through the peripheral vessels resulting, eventually, in damage to peripheral structures and loss of functional capacity. The majority of individuals suffering from vascular diseases also suffer from other diseases that affect their vascular system (e.g., heart disease, diabetes). Therefore, literature assessing the effects of peripheral vascular diseases on crash risk is often considered under other specific disease entities (coronary disease, cerebrovascular disease).

Despite the lack of available literature, current fitness-to-drive guidelines for medical practitioners from Australia (1998) and Canada (2000) have been developed for specific categories of peripheral vascular disease (e.g., aneurysms) or specific functional impairments as the result of peripheral vascular diseases (e.g., intermittent claudication). Those guidelines are summarized in Table 14.

Table 14  Guidelines for Peripheral Vascular Diseases (Reproduced with permission)