Peripheral vascular disease: Answers to common questions

Knowing signs and getting treatment can lower your risk for complications

Peripheral vascular disease: Answers to common questions

Peripheral vascular disease (PVD), which includes peripheral arterial disease (PAD), is a slow and progressive disorder of the blood vessels.

Narrowing, blockage, or spasms in a blood vessel can cause this disorder, which can affect any blood vessel outside the heart. This includes the arteries, veins, or lymphatic vessels.

Organs supplied by these vessels, such as the brain or legs, may not get enough blood flow for healthy function. The legs and feet are most often affected – and you can risk stroke or amputation if PVD goes untreated.

Kevin Schoepel, M.D., a specialist in vascular surgery at Sanford Bemidji Heart and Vascular Center, answered some frequently asked questions about this disease.

“PAD, or PVD, is a disease that can often be prevented,” Dr. Schoepel said. “Early detection and intervention is the key to avoiding invasive procedures but when there is no other option, it’s important to choose the right procedure. Getting it done early is the best way for it to be successful.”

This disease affects nearly 200 million people worldwide, including 40-45 million Americans. It is uncommon in young people but is present in more than 20% of people who are 80 years and older.

What causes peripheral vascular disease?

The most common cause of PVD is atherosclerosis – the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs. It decreases the oxygen and nutrients sent to the tissue. Blood clots may form on the artery walls. This makes the inner size of the blood vessels even smaller and blocks off major arteries.

Other causes of PVD may include:

  • Injury to the arms or legs
  • Irregular anatomy of muscles or ligaments
  • Infection

People with coronary artery disease (CAD) often also have PVD.

Who is at risk for peripheral vascular disease?

Risk factors that you can’t change include:

  • Age (higher risk over age 50)
  • History of heart disease
  • Men
  • Postmenopausal women
  • Family history of high cholesterol, high blood pressure, or peripheral vascular disease

Risk factors that may be changed or treated include:

  • Coronary artery disease
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Overweight
  • Physical inactivity
  • Smoking or use of tobacco products

Those who smoke or have diabetes have the highest risk of complications from PVD. This is because these risk factors cause impaired blood flow.

What are the symptoms of peripheral vascular disease?

About half the people diagnosed with PVD have no symptoms. For those with symptoms, the most common first symptom is painful leg cramping that occurs with exercise and is relieved by rest. This is known as intermittent claudication. During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs. This depends on the location of the clogged or 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 feet
  • Gangrene (dead tissue due to lack of blood flow)
  • Hair loss on the legs
  • Impotence
  • 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?

Your health care provider will ask about your medical history. They will give you a physical exam. You may also have tests such as:

  • Angiogram. This is an X-ray of the arteries and veins to find blockage or narrowing.
  • Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm.
  • Doppler ultrasound flow studies.  This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.
  • Magnetic resonance angiography (MRA).  This noninvasive test uses a large magnet, radio waves, and a computer to make detailed images of organs and other tissues in the body.
  • Treadmill exercise test. For this test, you will walk on a treadmill so your doctor can monitor blood flow 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.
  • Pulse volume recording (PVR) waveform analysis. Your doctor uses this test 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.

“Making a PVD diagnosis is important because it may be the first indication that a patient has atherosclerosis,” Dr. Schoepel said. “PVD is associated with heart disease and stroke and could be a sign that a patient needs to be treated for cardiovascular disease.”

What is the treatment for peripheral vascular disease?

The main goals for treatment of PVD are to control the symptoms and halt the progression of the disease. This is important to lower the risk for heart attack, stroke, and other problems.

Treatment may include:

  • Lifestyle changes to control risk factors.These include regular exercise, good nutrition, and not smoking.
  • Aggressive treatment of other problems that may worsen PVD.These include diabetes, high blood pressure, and high cholesterol.
  • Medicines to improve blood flow. These include antiplatelet medicines (blood thinners) and medicines that relax the blood vessel walls.
  • 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. This is done to reroute the blood flow.
  • Your doctor puts a catheter (thin, flexible tube) to create a larger opening in an artery. This is done to increase blood flow. There are several types of angioplasty procedures.

“Treatments now often involve less invasive options,” Dr. Schoepel said. “Catheters can clean out plaque using balloons, stents, lasers and other devices.”

What are possible complications of peripheral vascular disease?

Complications of PVD most often occur because of decreased or absent blood flow. These complications may include:

  • Amputation (loss of a limb)
  • Poor wound healing
  • Restricted mobility due to pain or discomfort
  • Severe pain in the affected extremity
  • Stroke (three times more likely in people with PVD)

Following an aggressive treatment plan for PVD can help prevent complications.

What can I do to prevent peripheral vascular disease?

To prevent PVD, take steps to manage the risk factors. A prevention program for PVD may include:

  • Quit smoking, avoid secondhand smoke, and don’t use any tobacco products
  • Dietary changes including reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables, low-fat dairy, and lean meats
  • Treatment of high blood cholesterol with medicine as determined by your health care provider
  • Weight loss
  • Limiting or quitting alcohol intake
  • Medicine to reduce your risk for blood clots, as determined by your health care provider
  • Exercise 30 minutes or more daily
  • Control of diabetes
  • Control of high blood pressure

Find a vascular specialist

Sanford Health provides vascular care across the Midwest. Find a vascular care specialist or vascular surgeon near you.

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Posted In Bemidji, Heart, Vascular