Peripheral Vascular Disease
What is peripheral
vascular disease?
Peripheral vascular disease (PVD) is a common
circulation problem in which the arteries that
carry blood to the legs or arms become narrowed
or clogged. PVD is sometimes called peripheral
arterial disease, or PAD. Many people also refer
to the condition as "hardening of the arteries."
This interferes with the normal flow of blood,
sometimes causing pain but often causing no symptoms
at all.
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What
causes peripheral vascular disease?
The most common cause of PVD is atherosclerosis
(often called hardening of the arteries). Atherosclerosis
is a gradual process in which cholesterol and
scar tissue build up, forming a substance called
"plaque" that clogs the blood vessels. In some
cases, PVD may be caused by blood clots that lodge
in the arteries and restrict blood flow.
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How
common is PVD?
PVD affects about 1 in 20 people over the age
of 50, or 8 million people in the United States.
More than half the people with PVD experience
leg pain, numbness or other symptoms - but many
people dismiss these signs as "a normal part of
aging" and don't seek medical help. Only about
half of those with symptoms have been diagnosed
with PVD and are seeing a doctor for treatment.
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What
are the symptoms of PVD?
The most common symptom of PVD is painful cramping
in the leg or hip, particularly when walking.
This symptom, also known as "claudication," occurs
when there is not enough blood flowing to the
leg muscles during exercise. The pain typically
goes away when the muscles are given a rest. Other
symptoms may include numbness, tingling or weakness
in the leg. In severe cases, you may experience
a burning or aching pain in your foot or toes
while resting, or develop a sore on your leg or
foot that does not heal.
People with PVD also may experience a cooling
or color change in the skin of the legs or feet,
or loss of hair on the legs. In extreme cases,
untreated PVD can lead to gangrene, a serious
condition that may require amputation of a leg,
foot or toes. If you have PVD, you are also at
higher risk for heart disease and stroke. Unfortunately,
the disease often goes undiagnosed because many
people do not experience symptoms in the early
stages of PVD or they mistakenly think the symptoms
are a normal part of aging.
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What
are the risk factors for PVD?
As many as 8 million people in the U.S. may have
PVD. The disease affects everyone, although men
are somewhat more likely than women to have PVD.
Those who are at highest risk are:
- over the age of 50
- smokers
- diabetic
- overweight
- people who do not exercise, or people who
have high blood pressure or high cholesterol.
- A family history of heart or vascular disease
may also put you at higher risk for PVD.
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Do
I have PVD?
- Do you have cardiovascular (heart) problems
such as high blood pressure, heart attack, stroke?
- Do you have diabetes?
- Do you have a family history of diabetes or
cardiovascular problems (immediate family such
as parent, sister, brother)?
- Do you have aching, cramping or pain in your
legs when you walk or exercise, but then the
pain goes away when you rest?
- Do you have pain in your toes or feet at night?
- Do you have any ulcers or sores on your feet
or legs that are slow in healing?
- Do you smoke?
- Have you ever smoked?
- Are you more than 25 pounds overweight?
- Do you eat fried or fatty foods three times
a week or more?
- Do you have an inactive lifestyle?
The more "Yes" answers you have, the more important
it is for you to contact an interventional radiologist.
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How
is PVD diagnosed?
The most common test for PVD is the ankle-brachial
index (ABI), a painless exam in which a special
stethoscope is used to compare the blood pressure
in your feet and arms. Based on the results of
your ABI, as well as your symptoms and risk factors
for PVD, the physician can decide if further tests
are needed. When the ABI indicates that an individual
may have PVD, other imaging techniques may be
used to confirm the diagnosis, including duplex
ultrasound, magnetic resonance angiography (MRA)
and computed tomography (CT) angiography.
The ABI is a simple, painless test to help your
physician determine if you have PVD. The blood
pressure in your arms and ankles is checked using
a regular blood pressure cuff and a special ultrasound
stethoscope called a Doppler. The pressure in
your ankle is compared to the pressure in your
arm to determine how well your blood is flowing
and whether further tests are needed.
If you suspect that you may have PVD, it is important
that you see your personal physician or an interventional
radiologist for an evaluation.
You also may want to participate in Legs For
Life™ - National Screening for PVD Leg Pain.
To find out about this free screening screening
program near you, visit the Legs
for Life web site.
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How
can PVD be treated?
The best treatment for PVD depends on a number
of factors, including your overall health and
the seriousness of the disease. In some cases,
lifestyle changes are enough to halt the progress
of PVD and manage the disease. Sometimes, medications
or procedures that open up clogged blood vessels
are prescribed to treat PVD.
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What
type of lifestyle changes can treat PVD?
In many cases, changes in lifestyle are enough
to slow the progression or even reverse symptoms
of PVD. Most treatment plans will include a low
fat diet and a program of regular exercise. If
you are a smoker, it is absolutely essential that
you stop the use of all types of tobacco. If decreased
blood flow to the legs is causing injury to the
feet and toes, a foot care program to prevent
sores or infection may be prescribed. This may
include referral to a podiatrist.
Exercise: Research has shown that regular
exercise is the most consistently effective
treatment for PVD. In study after study, patients
who have taken part in a regular exercise program
for at least three months have seen substantial
increases in the distances they are able to
walk without experiencing painful symptoms.
Exercise programs that have been effective include
simple walking regimens, leg exercises and,
most commonly, treadmill exercise programs three
to four times every week for a period of several
months. Some people may have a medical condition
that prevents them from participating in an
exercise program. Consult with your physician
before undertaking any exercise or other treatment
program.
Diet: Like many patients with coronary
artery disease caused by atherosclerosis, PVD
patients frequently have elevated cholesterol
levels that contribute to the disease. A low
fat diet and other cholesterol-lowering strategies
are often part of a treatment plan.
Stop Smoking: There is no doubt that
cigarette smoking is a strong risk factor for
PVD. On average, smokers are diagnosed with
PVD as much as 10 years earlier than non-smokers.
Stopping smoking now is the single most important
thing you can do to halt the progression of
PVD or prevent it in the future.
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Can
medications help?
For many patients, lifestyle changes combined
with medication can control the symptoms of PVD.
Drugs that lower cholesterol or control high blood
pressure may be prescribed. New medications that
help prevent blood clots or the build up of plaque
in the arteries, or that reduce the pain of PVD,
also are appropriate for some patients.
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What
procedures are available to help?
There are a number of ways that physicians can
open blood vessels at the site of blockages and
restore normal blood flow. In many cases, these
procedures can be performed without surgery using
modern, interventional radiology techniques. Interventional
radiologists are physicians who use tiny tubes
called catheters and other miniaturized tools
and X-rays to do 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.
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Interventional
radiology treatments for PVD
Angioplasty - a tiny balloon is placed
in the blood vessel at the site of the blockage.
It is then inflated to open the blood vessel.
Stents - a tiny metal cylinder, or stent,
is inserted in the clogged vessel to act like
a scaffolding and hold it open.
Thrombolytic therapy - clot-busting
drugs are delivered to the site of blockages
caused by blood clots.
Stent-grafts - a stent covered with
synthetic fabric is inserted into the blood
vessels to bypass diseased arteries.
Thrombolytic Therapy - This treatment
is used by an interventional radiologist if
the blockage in the artery is caused by a blood
clot. Thrombolytic drugs-sometimes called "clot
busters"-dissolve the clot and restore blood
flow. Usually, the drugs are administered through
a catheter directly into the clot. These drugs
are frequently combined with another treatment,
such as angioplasty.
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Are
there any surgical treatments for PVD?
Most cases of PVD can be treated with lifestyle
changes; medications; non-surgical, interventional
radiology procedures; or some combination of these
treatments. In some severe cases, however, surgery
may be required. Procedures performed by a vascular
surgeon include:
Thrombectomy - This procedure is used
only when symptoms of PVD develop suddenly as
a result of a blood clot. In the technique,
a balloon catheter is inserted into the affected
artery beyond the clot. The balloon is inflated
and pulled back, bringing the clot with it.
Thrombectomy usually requires surgery.
Bypass grafts - In this procedure, a
vein graft from another part of the body or
a graft made from artificial material is used
to create a detour around a blocked artery.
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How
do I know which treatment will be the best for
me?
The best treatment for PVD depends on a number
of factors, including your overall health, the
location of the affected artery, and the size
and cause of the blockage or narrowing in the
artery. You should discuss all your treatment
options with your physician. Some questions to
ask:
- Can my PVD be controlled with lifestyle changes?
- What medications might be appropriate for
me?
- If a procedure is required, am I a candidate
for a less invasive, interventional radiology
treatment?
- What are the risks and benefits of the treatment
plan prescribed for me?
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Reprinted with permission of the Society of Interventional
Radiology © 2002 www.sirweb.org.
Reviewed by:
Jeffrey A. Solomon, MD
January, 2003
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