What is Peripheral Vascular Disease?
Peripheral vascular diseases (PVDs) are circulation disorders that affect blood vessels outside of the heart and brain. PVD typically strikes the veins and arteries that supply the arms, legs, and organs located below your stomach. These are the blood vessels that are distant from the heart. They are known as peripheral vessels.
In PVD, blood vessels are narrowed. Narrowing is usually caused by arteriosclerosis. Arteriosclerosis is a condition where plaque builds up inside a vessel. It is also called “hardening of the arteries.” Plaque decreases the amount of blood and oxygen supplied to the arms and legs.
As plaque growth progresses, clots may develop. This further restricts the affected vessel. Eventually, arteries can become obstructed.
PVD that develops only in the arteries is called peripheral arterial disease (PAD). This is the most common form of PVD. Approximately 12 to 20 percent of people over age 65 have PAD.
PVD and PAD are often used to mean the same condition. PVD may also be referred to as:
- arteriosclerosis obliterans
- arterial insufficiency of the legs
- intermittent claudication
Types of PVD
There are two main types of PVD:
Functional PVD: This does not involve physical problems in the blood vessels. It causes incidental or short-term symptoms. These are usually spasms that occur erratically.
Organic PVD: This involves changes in blood vessel structure. This type of PVD causes inflammation, tissue damage, and blockages.
Causes of PVD
The body responds to certain external stimuli by restricting blood flow to the peripheral vessels. The most common causes of functional PVDs are:
- emotional stress
- cold temperatures
- operating vibrating machinery or tools
Physical changes can affect the structure of blood vessels. For example, arteriosclerosis can cause plaque buildup. The primary causes of such organic PVDs are:
- high blood pressure
- high cholesterol
Additional causes of organic PVDs include:
- injury to extremities
- muscles or ligaments with abnormal structures
- coronary artery disease
Risk Factors for PVD
There are numerous risk factors for PVD. Some are due to underlying medical conditions, age and gender while others are due to lifestyle choices.
You are at a higher risk for acquiring PVD if you are a man over age 50 or a postmenopausal woman. The likelihood of developing PVD also increases if you have:
- abnormal cholesterol
- cerebrovascular disease (stroke) —
- heart disease
- diabetes mellitus (type 1 diabetes)
- family history of high cholesterol, high blood pressure, or PVD
- high blood pressure
- kidney disease on hemodialysis
The lifestyle choices that can increase your risk of developing PVD are:
- being overweight
- being sedentary and not engaging in physical exercise
Symptoms of PVD
For many people, there are no symptoms of PVD. For others, the first signs of PVD begin slowly and irregularly. You may feel discomfort in your legs and feet. You may experience:
Typically, you will feel these sensations when you walk. You may first notice them when walking quicker, with more exertion, or for long distances. The pain will intensify with activity and subside when you rest. This is called intermittent claudication.
Intermittent claudication occurs because your muscles need more blood flow during activity. In PVD, the vessels are narrowed with plaque. They can only supply a limited amount of blood. This causes more problems during activity than at rest. Lack of blood causes pain and discomfort.
As your PVD progresses, symptoms will occur more frequently. It will require less exertion to bring them on. Eventually, you will experience leg pain and fatigue even at rest.
Additional symptoms may occur as a result of reduced blood supply. With PVD, you may have:
- skin changes on your legs and feet (thinning, , shiny, or paleness may occur)
- weak pulses in your legs and feet
- gangrene—tissue death caused by lack of blood flow
- wounds or ulcers on the legs and feet that won’t heal
- reduced hair growth on your legs
- toes that turn blue
- severe burning pain in your toes
- leg cramps and pain when you are lying in bed
- muscles that feel numb or heavy
- arms and legs that are reddish blue
- toenails that are thick and opaque
It is important to tell your doctor if you experience any symptoms of PVD. Do not assume that the symptoms are simply the results of aging. Delaying diagnosis and treatment could allow the disease to progress further
Complications of PVD
Complications from undiagnosed and untreated PVD can be serious and even fatal. The restricted blood flow of PVD can be a warning sign of other forms of vascular disease. When arteries leading to the heart and brain become clogged with plaque, it can cause:
- heart attack
Complications of PVD can include:
- blood clots that obstruct small arteries
- coronary artery disease
- limb amputation due to tissue death in the limb
- heart attack
- pallor, or paleness
- pain when the legs are elevated
- severe pain that restricts mobility
- wounds that don’t heal
Diagnosis of PVD
If you have any of the classic symptoms of PVD, it is important to tell your doctor. Early diagnosis is crucial to successful treatment. It can prevent life-threatening complications, such as heart attack and stroke.
To diagnose PVD, your physician will begin with a complete medical history and physical exam. Several tests may be used to diagnose PVD. They are:
- measuring the pulses in your legs and feet—Your physician can check the pulses in your legs and feet with a stethoscope. A whooshing sound called a bruit indicates a narrowed area in the vessel.
- Doppler ultrasound—This test shows the blood flow in your vessels. Ultrasound is not invasive. It uses sound waves to take images.
- ankle-brachial index (ABI)—This is the most common test used to diagnose PVD. A blood pressure cuff and ultrasound assess blood pressure and flow. The blood pressure in your ankle is compared to the blood pressure in your arm. In some cases, readings will be taken before and after you walk on a treadmill. This helps demonstrate how the arteries react to exercise.
- pulse volume recording (PVR)—This test checks the blood flow in your legs. Blood pressure cuffs are wrapped around one arm and leg as you are lying down. The cuffs are inflated slightly. As blood flows through the arteries, a device records the ability of the vessels to expand.
- Angiography—A catheter is guided through an artery in your groin. It is passed to the targeted area. Contrast dye is injected. An X-ray can then diagnose the clogged artery. By inflating a balloon at the end of the catheter, the artery can be opened in the same procedure.
- magnetic resonance angiography (MRA) and computerized tomography angiography (CTA)—These are noninvasive imaging techniques that allow doctors to view blood flow and diagnose blockages.
Treatment of PVD
There are two main goals of PVD treatment. The first is to control pain and symptoms. This allows you to remain active. The second is to stop the disease from progressing. This will lower your risk of serious and life-threatening complications.
Treatment typically includes lifestyle modifications. You will need to:
- stop smoking
- commit to a regular exercise program that includes walking
- eat a balanced diet with proper nutrition
- stop smoking
- lose weight
- treat conditions such as diabetes, high blood pressure, or high cholesterol
Smoking cessation is one of the most important ways to treat PVD. Smoking directly causes reduced blood flow in vessels.
If lifestyle changes don’t control your PVD, you may need medication. Medications for PVD include:
- cilostazol or pentoxifylline—to increase blood flow to the legs, ease leg pain, and relieve symptoms of claudication
- clopidrogel or daily aspirin—to reduce risk of blood clots. Clots could cut off the blood supply to a limb. This puts you at risk of amputation.
- atorvastatin, simvastatin, or other statins—to lower high cholesterol
- angiotensin-converting enzyme (ACE) inhibitors—to lower high blood pressure
- Diabetes medication to control blood sugar if you have diabetes
Significant artery blockages may require surgery. There are several surgical treatments for PVD.
Angioplasty is performed by inserting a catheter or long tube into the blocked artery. A balloon on the tip of the catheter is inflated. This opens the blockage. In some cases a stent is placed in the artery to keep it open. A stent is a small wire tube.
Vascular surgery bypasses the blocked vein. A vein from another part of your body, or a synthetic graft, is attached to the affected vein. This allows blood to bypass the narrow area.
Prognosis for PVD
If diagnosed early, most cases of PVD will respond to lifestyle treatments. One way to measure improvement is to determine how far you can walk without pain. With effective treatment, you should be able to gradually increase the distance.
Contact your doctor if your symptoms get worse or you experience any of the following:
- your leg looks pale or blue
- your leg becomes cold
- chest pain accompanies leg pain
- your leg becomes red, swollen, or hot
- new sores or ulcers develop and do no heal
- you experience fever, chills, weakness, or other signs of infection
How to Prevent PVD
You can reduce your risk of developing PVD by having a healthy lifestyle. This includes:
- avoiding smoking
- controlling your blood sugar, if you have diabetes
- setting an exercise goal of 30 minutes a day, three times a week
- working to lower cholesterol and blood pressure
- eating a healthy diet that is low in saturated fat
- keeping your weight at a healthy level
If you experience symptoms of PVD, talk to your doctor. Your doctor may also recommend testing if you are at risk for the disease.
Early diagnosis and treatment can keep symptoms to a minimum. They can also increase the effectiveness of your treatment.