Peripheral Vascular Disease
What is peripheral vascular disease?
Peripheral vascular disease (PVD) or peripheral arterial disease (PAD) is a slow and progressive circulation disorder. PVD may affect any blood vessel outside of the heart, however, the legs and feet are most commonly affected.
What causes PVD/PAD?
The most common cause is atherosclerosis, the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs. It also decreases the oxygen and nutrients available to the tissues.
Who is at risk for PVD/PAD?
Risk factors that cannot be changed:
- Age(especially over 50)
- History of heart disease
- Male gender
- Postmenopausal women
- Family history of high cholesterol, high blood pressure, or peripheral vascular disease
Risk factors that may be changed or treated:
- Coronary artery disease
- High cholesterol
- Physical inactivity
- Smoking or tobacco use
What are the symptoms of peripheral vascular disease?
About half the people diagnosed with PVD are symptom free. For those with symptoms, the most common first symptom is painful leg cramping that occurs with exercise and is relieved by rest (intermittent claudication). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the narrowed artery.
Other symptoms of PVD may include:
- Changes in the skin, including decreased skin temperature, or thin, brittle, shiny skin on the legs and feet
- Weak pulses in the legs and the feet
- Gangrene (dead tissue due to lack of blood flow)
- Hair loss on the legs
- Wounds that won't heal over pressure points, such as heels or ankles
- Numbness, weakness, or heaviness in muscles
- Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
- Paleness when the legs are elevated
- Reddish-blue discoloration of the extremities
- Restricted mobility
- Severe pain when the artery is very narrow or blocked
- Thickened, opaque toenails
How is peripheral vascular disease diagnosed?
Along with a complete medical history and physical exam, other tests may include:
- Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
- Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.
- Doppler ultrasound flow studies. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Your doctor may use the Doppler technique to measure and assess the flow of blood. Faintness or absence of sound may mean blood flow is blocked.
- Magnetic resonance angiography (MRA). This noninvasive test uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures in the body. Your doctor injects a special dye during the procedure so that blood vessels are more visible.
- Treadmill exercise test. For this test, you will walk on a treadmill so your doctor can monitor blood circulation during exercise.
- Photoplethysmography (PPG). This exam is comparable to the ankle brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements. Your doctor can then compare these measurements to the systolic blood pressure in the arm.
- Pulse volume recording (PVR) waveform analysis. Your doctor uses this technique to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.
- Reactive hyperemia test. This test is similar to an ABI or a treadmill test but used for people who can't walk on a treadmill. While you are lying on your back, your doctor takes comparative blood pressure measurements on the thighs and ankles to determine any decrease between the sites.
What is the treatment for PVD/PAD?
The main goals for treatment of PVD are to control the symptoms and halt the progression of the disease to lower the risk for heart attack, stroke, and other complications.
Treatment may include:
- Lifestyle changes to control risk factors, including regular exercise, proper nutrition, and quitting smoking
- Aggressive treatment of existing conditions that may worsen PVD, such as diabetes, high blood pressure, and high cholesterol
- Medicines to improve blood flow, such as antiplatelet agents (blood thinners) and medicines that relax the blood vessel walls
- Angioplasty — your doctor inserts a catheter (long hollow tube) to create a larger opening in an artery to increase blood flow. There are several types of angioplasty procedures, including:
- Balloon angioplasty (a small balloon is inflated inside the blocked artery to open the blocked area)
- Atherectomy (the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter)
- Laser angioplasty (a laser is used to "vaporize" the blockage in the artery)
- Stent (a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open)
- Vascular surgery —a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow