Peripheral Vascular Disease (PVD)
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What is Vascular Peripheral Disease?
Peripheral vascular disease, or PVD, is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged, interfering with the normal flow of blood. 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. PVD also may be caused by blood clots that lodge in the arteries and restrict blood flow.
How Common Is PVD?
PVD affects about one in 20 people over the age of 50, or 10 million people in the United States. More than half of those 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. PVD affects both men and women.
What Are the Symptoms of PVD?
The most common symptom of PVD is called intermittent claudication, which is painful cramping in the leg or hip, particularly when walking. Intermittent 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.
PVD Symptoms:
- leg or hip pain while walking
- pain stops when you rest
- numbness
- tingling
- weakness in the legs
- burning or aching pain in feet or toes when resting
- sore on leg or foot that won?t heal
- cold legs or feet
- color change in skin of legs or feet
- loss of hair on legs
Who Is at Risk for PVD?
As many as 10 million people in the United States may have PVD. It is estimated that four million of them suffer leg pain symptoms. Those who are at highest risk are:
- over the age of 50
- smokers
- diabetic
- overweight
- people who do not exercise
- 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.
How Can I Find Out if I Have PVD?
If you suspect that you may have PVD, it is important that you see your personal physician for an evaluation.
How Is PVD Diagnosed?
The most common test for PVD is the ankle-brachial index (ABI), a simple, painless exam in which a regular blood pressure cuff and a special ultrasound stethoscope, called a Doppler, is used to measure the ratio of blood pressure in your feet and arms. This ratio determines how well your blood is flowing. Based on the results of your ABI, as well as your symptoms and risk factors for PVD, your physician can decide if further tests are needed. PVD also can be diagnosed noninvasively with an imaging technique called magnetic resonance angiography (MRA), or with computed tomography (CT) angiography.
How Is PVD Treated?
The best treatment for PVD depends on a number of factors, including your overall health and the severity of the disease. In some cases, lifestyle changes are enough to halt the progress of PVD and manage the disease. Your physician may prescribe drugs when lifestyle changes are not enough. Procedures that open clogged blood vessels also are used to treat PVD.
- Lifestyle Changes. Most treatment plans will include
a low fat diet and other cholesterol-lowering strategies, as well as
a program of regular exercise. 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.
If you are a smoker, it is absolutely essential that you stop the use of all types of tobacco. 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. 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.
- Medication. Medications that lower cholesterol or control high blood pressure may be prescribed. Medication also is available that has been shown to significantly increase pain-free walking distance and total walking distance in people with intermittent claudication. Other medications that help prevent blood clots or the build-up of plaque in the arteries are available as well.
What Can Be Done to Treat PVD When Lifestyle Changes and Medications Are Not Enough?
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.
Procedures performed by interventional radiologists include:
- 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.
Sometimes, open surgery is required to remove blockages from arteries or to bypass the clogged area. These procedures are performed by vascular surgeons.
How Do I Know Which Treatment Will Be 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?
Excerpts were reprinted with permission of the Society of Interventional Radiology ©2004, www.sirweb.org.
