Definition & Overview

Peripheral Vascular Disease (PVD) a medical condition that is characterized by the narrowing of arteries outside of the heart and brain. The blood vessels that are commonly affected are the ones that supply blood to the arms, legs, and organs below the stomach. These are the Tibial arteries, Popliteal artery, Iliac artery, and Femoral artery.

One of the major causes of PVD is a condition called arteriosclerosis, which is described as the hardening of the arteries due to plaque. Narrow arteries not only hamper the flow of blood but can also cause blood clots. These clots can block the artery and prevent blood from passing through.

PVD is sometimes used interchangeably with another condition called Peripheral Arterial Disease (PAD). It is also referred to as asteriosclerosis obliterans, claudication, intermittent claudication, and arterial insufficiency of the legs.

There are two types of PVD: Functional and Organic. In Functional PVD, there are no changes in the structure of the blood vessels. The symptoms are only short term, such as erratic spasms. In Organic PVD, the physical structure of the blood vessel changes due to an infection, blockage, or tissue damage.

PVD is a serious condition. If left untreated, it can lead to gangrene, which would eventually lead to amputation of the affected limb. PVD patients are also at risk of developing heart problems or a stroke.

Cause of Condition

The primary cause of PVD is arteriosclerosis, or the formation of fatty plaque in the arteries. When plaque continues to build up, it narrows the artery, reducing the amount of blood that flows to the limbs. In severe cases, the artery can be totally blocked.

Other causes of PVD are inflammation of the artery, injuries, radiation exposure, or abnormalities in the structure of the muscles and ligaments.

Smoking, diabetes, and obesity are the primary risk factors of PVD. People with hypertension, high cholesterol, and high levels of homocysteine are also at risk of developing the condition. If you have a family history of heart diseases and stroke, and you’re over the age of 50, the risks also increase.

It’s imperative that you notice the symptoms of the disease so that it can be treated before complications, such as a stroke and heart attack, develop. Another common complication of PVD is critical limb ischemia, which is described as sore on the feet or legs that refuse to heal. In time, gangrene will develop and the affected limb will need to be amputated to prevent the infection from spreading to other parts of the body.

Key Symptoms

The most common symptom of PVD is pain in the legs while performing an activity, such as walking. The pain subsides while resting. This condition is referred to as intermittent claudication. Some people may only experience mild symptoms, while in others, the symptoms can be severe.

However, not all PVD patients display symptoms of the condition. In fact, many patients do not display any type of symptom at all.

Other symptoms of PVD are a weak pulse or no pulse in the legs, erectile dysfunction in men, weakness of the affected limb, sores on the feet that refuse to heal, legs turning into a different color, hair loss on the legs, and shiny skin on the legs.

It’s normal to experience pain in the legs as we age. However, keep in mind that not all pain is a result of aging. If you experience any of the above symptoms, it’s best that you consult your doctor to determine the exact cause.

Who to See & Types of Treatment Available

Your family doctor is the first person to see if you notice any of the above-mentioned symptoms. If you don’t display any of those symptoms, yet you do have risk factors, it is advisable that you undergo regular health checkups.

The doctor will first review your medical history and history of diseases in the family. You will then undergo a physical examination, wherein the doctor will look for any signs of PVD, such as a weak or absent pulse in the legs.

Another way the doctor can determine the presence of PVD is to perform an ankle-brachial index (ABI). This test involves measuring the blood pressure in the ankle and arm. The results will then be compared.

Other diagnostic tests are an ultrasound, angiography, and blood tests. In an angiography, the doctor will inject a dye into your bloodstream. The dye is visible on an x-ray, which helps doctors analyze the flow of blood through your body. If the blood vessel is narrowed or blocked, the doctor will be able to pinpoint the exact location.

Treatment of PVD involves reducing the symptoms and preventing arteriosclerosis from progressing. This will minimize the risk of a heart attack or stroke.

If the condition is mild, you may not require any medical treatment, but your doctor will suggest lifestyle changes, such as quitting smoking and eating a healthy diet.

If your condition does require treatment, you’ll be prescribed with cholesterol-lowering medications, blood pressure medications, medications that control your blood sugar, blood clot prevention medications, and medications that not only prevent blood clots but widen the artery as well.

Severe cases of PVD may require surgery together with medications. Surgery procedures to treat PVD include angioplasty, bypass surgery, and thrombolytic therapy. In angioplasty, the surgeon will insert a balloon-tipped catheter into a major blood vessel. The catheter is directed to the location of the blockage or narrowed artery. Once there, the small balloon at the tip is inflated to widen the artery and improve blood flow. In some cases, a wire mesh called a stent is inserted at the location to prevent it from collapsing.

In a bypass surgery, the doctor harvests a blood vessel from other parts of the body. One end of the blood vessel will be connected to the area before the narrowed or blocked portion. The other end will be attached to an area after the blocked portion thus effectively creating a bypass.

References:

  • White CJ. Atherosclerotic Peripheral Arterial Disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 67.

  • Mills JL. Lower extremity arterial disease. In: Cronenwett JL, Johnston W, eds. Rutherford's Vascular Surgery. 7th ed. Philadelphia, PA: Saunders Elsevier; 2010:section 15.

  • Creager MA, Libby P. Peripheral arterial disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders; 2011:chap 61.

  • Wong PF, Chong LY, Mikhailidis DP, Robless P, Stansby G. Antiplatelet agents for intermittent claudication. Cochrane Database Syst Rev. 2011. Issue 11. Art No.: CD001272. DOI: 10.1002/14651858.CD001272.pub2.

  • Watson L, Ellis B, Leng GC. Exercise for intermittent claudication. Cochrane Database Syst Rev. 2008. Issue 4. Art No.: CD000990. DOI: 10.1002/14651858.CD000990.pub2.

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