Peripheral Vascular Disease (PVD)
What is peripheral vascular disease?
PVD (also sometimes called Peripheral Arterial Disease) is a common circulation condition in which the arteries that carry blood to the legs (peripheral) become narrowed or clogged, slowing or stopping the normal flow of blood. Infrequently, the arms may be affected, as well.
What causes PVD?
The most common cause of PVD is atherosclerosis, or hardening of the arteries. Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming plaque, which clogs the blood vessels. Blood clots that lodge in the arteries and restrict blood flow can also cause PVD.
This disease, which affects both men and women, interferes with the normal flow of blood. So, it often goes undiagnosed because many people mistakenly think the symptoms are a normal part of aging.
What are the symptoms of PVD?
- Leg or hip pain during walking that stops when you rest
- Numbness
- Tingling
- Weakness in the legs
- Burning or aching pain in feet or toes while resting
- Sore on leg or foot that won’t heal
- Cold legs or feet
- Color change in skin of legs or feet
- Loss of hair on legs
The most common symptom of PVD is called intermittent claudication, a painful cramping in the leg or hip, especially when walking. This occurs when there is not enough blood flowing to the leg muscles during exercise. The pain disappears at rest.
In extreme cases, if PVD is left untreated, tissue will die, which can lead to gangrene, a serious condition that may require amputation of a leg or foot.
You are also at higher risk for heart disease and stroke if you have PVD.
Who is at risk?
As many as 10 million Americans – or one in 20 people over age 50 - may have PVD. It is estimated that 4 million of those suffer leg pain symptoms. Those who are at highest risk are:
- Over age 50
- Smokers
- Diabetics
- Overweight
- People who do not exercise, or
- People with high blood pressure, or high cholesterol
- People with coronary artery disease (CAD)
A family history or other vascular disease may also put you at higher risk for PVD.
How is PVD diagnosed?
An ankle-brachial index (ABI) is a common screening test in which blood pressure cuffs and stethoscopes are used to measure the ratio of blood pressure in the feet and arms. Diagnostic testing may include noninvasive imaging techniques such as magnetic resonance angiography (MRI), computed tomography (CT) angiography or an ultrasound. A Doppler or ultrasound study of arteries in the legs, called a PV study, is also used in diagnosis. In some cases an arteriogram (injection of x-ray dye directly into the arteries) may be recommended as well.
What treatment is available?
In some cases, lifestyle changes are enough to halt the progression of PVD and manage the disease. Most treatment plans include a low fat diet and program of regular exercise. If you smoke, you must stop using all types of tobacco. Tobacco use contributes to the amount of build-up or blockage in arteries and decreases the amount of oxygen supplied to your tissues.
If decreased blood flow to the legs is affecting the feet and toes, a foot care program to prevent sores or infection may be prescribed. A severe lack of blood supply to the legs can potentially cause gangrene that requires amputation of all or part of the foot and leg.
Medications that lower cholesterol or control high blood pressure may be prescribed. Other medications available help prevent blood clots or the build-up of plaque in the arteries.
If lifestyle or medications are not enough, your physician may refer you to an interventional radiologist, a physician who uses tiny tubes called catheters and other miniaturized tools and x-rays to do these procedures:
- Angioplasty – a balloon is inserted and then inflated to open the blockage or narrowing of the blood vessel.
- Catheter-directed thrombolytic therapy – clot-busting drugs are delivered through a catheter directly to the site of blockages caused by blood clots.
- Stents – a tiny metal cylinder, or stent, is inserted into the clogged vessel to act like scaffolding and hold it open.
- Stent-grafts – a stent covered with synthetic fabric is inserted into the abdominal aorta to strengthen diseased arteries. Used in treating abdominal aortic aneurysms.
Mercy provides all of these procedures.
Sometimes open surgery is required to remove blockages from arteries or to bypass the clogged area. These procedures are performed by vascular surgeons.
If you are experiencing any of the above PVD symptoms, contact your physician and ask for an ABI. Mercy provides ABI screenings each autumn, and visits some physician offices to conduct these tests.
To determine if you are at risk for PVD, take this risk assessment test.
For more information on PVD and other circulatory conditions from the Vascular Disease Foundation, click here www.vdf.org or from the Society of Interventional Radiology at www.sirweb.org.
