Peripheral Vascular Disease & Peripheral Artery Disease

What Is It?

Peripheral vascular disease (PVD) is a slow and progressive circulation disorder that impedes blood flow, most commonly to the legs and feet. When PVD occurs in the arteries outside the heart, it may be referred to as peripheral arterial disease (PAD), though more often these terms are used interchangeably.

Medical conditions associated with PVD/PAD:

• Atherosclerosis
• Buerger's disease (thromboangiitis obliterans)
• Chronic venous insufficiency
• Deep vein thrombosis (DVT)
• Raynaud's disease
• Thrombophlebitis
• Varicose Veins 

Risk Factors

Risk factors you cannot control:

• Age (older than 50)
• History of heart disease
• Male
• Diabetes mellitus (type 1 diabetes)
• Postmenopausal women
• Family history of dyslipidemia (elevated lipids in the blood, such as cholesterol), hypertension, or peripheral vascular disease
• Race

Risk factors that may be changed or treated:

• Coronary artery disease
• Impaired glucose tolerance
• High cholesterol
• Hypertension (high blood pressure)
• Obesity
• Physical inactivity
• Smoking

Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow.

Symptoms

Intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest) is the most common symptom, though half of people diagnosed with PVD have no symptoms at all. Other symptoms of peripheral vascular disease may include:

• Changes in the skin, including coolness or thin, brittle shiny skin on the legs and feet
• Diminished pulses in the legs and the feet
• Gangrene (dead tissue due to lack of blood flow)
• Hair loss on the legs
• Impotence
• Non-healing wounds over pressure points, such as heels or ankles
• Numbness, weakness, or heaviness in muscles
• Pain (burning or aching) at rest, commonly in the toes and at night while lying flat
• Pallor when the legs are elevated
• Reddish-blue discoloration of the extremities
• Restricted mobility
• Thickened, opaque toenails

Diagnosis

In addition to a complete medical history and physical examination, diagnostic procedures for peripheral vascular disease may include the following:

• Angiogram - an x-ray of the arteries and veins to detect blockage or narrowing of the vessels.
• Ankle-brachial index (ABI) - a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device.
• Blood lipid profile - a blood test to measure the levels of each type of fat in your blood: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and others.
• Doppler ultrasound flow studies - uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Doppler technique is used to measure and assess the flow of blood. Faintness or absence of sound may indicate an obstruction in the blood flow.
• Magnetic resonance angiography (MRA) - a noninvasive diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRA is often used to examine the heart and other soft tissues and to assess blood flow.
• Treadmill exercise test - a test that is given while a patient walks on a treadmill to monitor the heart during exercise.
• Photoplethysmography (PPG) - an examination 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 - a technique used to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.
• Reactive hyperemia test - a test similar to an ABI or a treadmill test but used for people who are unable to walk on a treadmill. While a person is lying on his or her back, comparative blood pressure measurements are taken on the thighs and ankles to determine any decrease between the two sites.
• Segmental blood pressure measurements - a means of comparing blood pressure measurements using a Doppler device in the upper thigh, above and below the knee, at the ankle, and on the arm to determine any constriction in blood flow.

Treatment

Treatment of PVD is aimed at both controlling the symptoms and also reducing the risk of heart attack, stroke, and other complications. Treatment options include:

• Lifestyle modifications
• Aggressive treatment of conditions that affect PVD, such as diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol)
• Medications for improving blood flow, such as blood thinners, and medications that relax the blood vessel walls
• Angioplasty - a catheter (long hollow tube) is used to create a larger opening in an artery to increase blood flow.
• Surgical Bypass  - 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 to reroute the blood

For more information or to make an appointment please call
1-877-233-WELL (9355).