Peripheral Vascular Disease
What Is Peripheral Vascular Disease?
Peripheral vascular disease (PVD), also sometimes referred to as peripheral artery disease, results from a narrowing of the arteries in the legs and sometimes the arms, generally due to atherosclerosis, the buildup of plaque in the arterial walls. Also known as “atherosclerosis obliterans” this condition causes reduced blood flow to the extremities, usually the legs and feet. The reduced blood flow is caused by plaque—composed of cholesterol-rich fatty deposits, collagen, other proteins, and excess smooth muscle cells—that gradually accumulates in the arteries. Thickening of the arterial walls narrows the vascular channels and impedes blood flow. During walking or other activities the narrowed arteries are unable to supply enough blood and oxygen to the muscles, causing pain, most commonly in the calves. Peripheral vascular disease shares the same risk factors as coronary heart disease, and the diseases often occur together.
Who Gets Peripheral Vascular Disease?
Peripheral vascular disease is most common after the age of 50, and occurs in both men and women. Although various leg pains may be common with aging, leg cramps that repeatedly occur at the same distance with walking or running—and are relieved by resting for a few moments—are an indicator of circulatory problems in the legs. According to the National Heart, Lung, and Blood Institute PVD affects approximately 8 to 12 million people in the United States. About 5% of people over the age of 50 and as many as 20% of people over the age of 65 may have PVD. Some research suggests the condition affects one out of three people who are over 50 and suffer from diabetes.
PVD is more common among minorities, especially African-American women. African-Americans are more than twice as likely than Caucasians to suffer from PVD. Being smoker or former smoker, or having high blood pressure, high cholesterol and a history of heart attack, stroke or vascular disease also increases your risk for PVD.
Symptoms can range from mild to debilitating, and interfere with daily functioning.
- Muscle pain in the calves or thighs of one or both legs that occurs when walking, especially fast or uphill. Pain subsides with rest. It may also occur in the fingers, arms, buttocks, lower back, or the arch of the foot, usually with some form of exertion.
- Numb, cold or weak legs.
- Changing toenail color and texture.
- Discoloration or hair loss on the legs.
- Erectile dysfunction.
- Muscle pain at rest that worsens at night; discolored or blue toes; cold or numb feet; numbness in the affected area when at rest; sores on the feet or legs that do not heal; added sensitivity to cold, or weak or absent pulse in the affected limb; scaly or hairless skin over the affected area. These symptoms usually indicate more advanced disease.
PVD is caused by atherosclerosis or a hardening and narrowing of the arteries, and is associated with an increased risk for heart disease, heart attack and stroke. Causes and risk factors include:
- Smoking (the greatest risk factor)
- High blood pressure
- High cholesterol levels
- Being 50 or older, with risk increasing as you age
What If You Do Nothing?
The disease may worsen if left untreated, in some cases even leading to tissue death or gangrene.
- Patient history and physical examination.
- Blood pressure measurements in the arms and legs.
- X-rays of the arteries after the injection of a contrast material or angiography.
- Ultrasound or magnetic resonance imaging.
- Don’t smoke.
- Get regular exercise. Experts recommend a minimum of 30 minutes a day of moderate exercise, such as walking. Regular exercise improves blood flow. Stop if you feel pain. For patients with difficulty moving, exercise can be done at a rehabilitation center under the guidance of a trained physical therapist.
- Keep blood pressure, cholesterol and blood sugar levels in check. Sometimes this can be accomplished through diet and exercise; sometimes medications may be necessary.
- Maintain a healthy weight.
- Wear supportive shoes.
- Practice good foot care and check your feet every day. Poor circulation due to PVD slows the healing of sores. Spotting problems early may help to prevent minor foot problems from becoming major infections.
- Over-the-counter or prescription pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs may reduce leg pain associated with PVD. Daily doses of aspirin may be prescribed to prevent blood clots that can lead to heart attack or stroke.
- Intermittent claudication also may be treated with pentoxifylline (Trental) or cilostazol (Pletal), which can improve blood flow.
- Antihypertensives may be prescribed to lower blood prsessure.
- Statin medications can be used to lower elevated blood cholesterol levels that can’t be controlled by lifestyle measures alone.
- Insulin, non-insulin injectable agents, and oral antidiabetic medications may be used to control blood sugar levels in patients who have diabetes.
- Antiplatelets such as aspirin or Plavix “thin” the blood and reduce the risk for blood clots.
Surgery. If lifestyle and medication approaches do not work, a variety of surgical procedures may be performed to open blood vessels in the legs and restore blood flow.
Angioplastyinvolves making a small incision and inserting a tube (catheter) into the affected artery to the blockage. A tiny balloon is then passed through the catheter and is inflated to dilate the artery.
Astent— a tiny wire device that resembles a spring but acts as a scaffold for the blood vessel—is placed into the artery during angioplasty and left in the artery so that it remains open. In some cases, medication is administered through the catheter to dissolve the plaque, or tiny instruments may be passed through the catheter and used to remove the blockage.
Other types of surgery include removal of the lining of the affected artery, called endarterectomy, and repairing or replacing the artery, called an arterial graft. In bypass surgery, a blood vessel from another part of the body is removed and implanted to redirect blood flow around the blocked artery.
If a blood clot suddenly blocks your artery, your doctor can inject it with a clot-dissolving substance.
A healthy lifestyle that involves regular physical activity and a balanced, low-fat diet can reduce the risk for PVD as well as other vascular-related conditions, including heart disease and stroke.
- Don’t smoke.
- Exercise regularly.
- Eat a diet low in saturated fat, cholesterol, and salt.
- Have your cholesterol and blood pressure checked, and treated if levels are too high.
- Lose weight if overweight.
When To Call A Doctor
Make an appointment with a doctor if you repeatedly experience muscle pain when walking or at rest, or if you have a foot sore or ulcer that does not quickly heal.
Reviewed by Larry A. Weinrauch, M.D., Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network.