Peripheral Vascular Disease

Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart and diseases of the lymph vessels -- the arteries, veins or lymphatic vessels. Organs supplied by these vessels such as the brain, heart and legs, may not receive adequate blood flow for ordinary function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

Conditions associated with PVD that affect the veins include deep vein thrombosis (DVT), varicose veins and chronic venous insufficiency. Lymphedema is an example of PVD that affects the lymphatic vessels.

When PVD occurs in the arteries outside the heart, it may be referred to as peripheral arterial disease (PAD). However, the terms "peripheral vascular disease" and "peripheral arterial disease" are often used interchangeably. It's frequently found in people with coronary artery disease, because atherosclerosis, which causes coronary artery disease, is a widespread disease of the arteries.

What Causes Peripheral Vascular Disease

PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis (the buildup of plaque inside the artery wall). Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.

Other causes of peripheral vascular disease may include trauma to the arms or legs, irregular anatomy of muscles or ligaments, or infection. People with coronary artery (arteries that supply blood to the heart muscle) disease are frequently found to also have peripheral vascular disease. 

Risk Factors for Peripheral Vascular Disease

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history or many other things. Risk factors for peripheral vascular disease include factors which can be changed or treated and factors that cannot be changed.

Risk factors that cannot be changed include:

  • Age (especially older than age 50)
  • History of heart disease
  • Male gender
  • Diabetes mellitus
  • Postmenopausal women
  • Family history of dyslipidemia (elevated lipids in the blood, such as cholesterol), high blood pressure, or peripheral vascular disease

Risk factors that may be changed or treated include:

  • Coronary artery disease
  • Impaired glucose tolerance
  • Dyslipidemia
  • High blood pressure
  • Obesity
  • Physical inactivity
  • Smoking or use of tobacco products

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 of Peripheral Vascular Disease

Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is leg discomfort described as painful cramping that occurs with exercise and is relieved by rest. Other symptoms of peripheral vascular disease may include:

  • Changes in the skin, including decreased skin temperature, 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 (described as burning or aching) at rest, commonly in the toes and at night while lying flat
  • Pallor (paleness) when the legs are elevated
  • Reddish-blue discoloration of the extremities
  • Restricted mobility
  • Severe pain
  • Thickened, opaque toenails

The symptoms of peripheral vascular disease may resemble other conditions. Consult your physician for a diagnosis. 

Treatment for Peripheral Vascular Disease

There are two main goals for treatment of peripheral artery/vascular disease: control the symptoms; and halt the progression of the disease to lower the risk for heart attack, stroke and other complications. Treatment may include:

  • Lifestyle modifications to control risk factors, including regular exercise, proper nutrition and smoking cessation
  • Aggressive treatment of existing conditions that may aggravate PVD, such as diabetes, hypertension and 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; angioplasty may be performed in many of the arteries in the body; there are several types of angioplasty procedures
  • 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 to reroute the blood flow

With both angioplasty and vascular surgery, an angiogram is often performed prior to the procedure.

Complications of Peripheral Vascular Disease

Complications of peripheral vascular disease most often occur because of decreased or absent blood flow. Such complications may include:

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

By following an aggressive treatment plan for peripheral vascular disease, complications such as these may be prevented.

Preventing Peripheral Vascular Disease

Steps to prevent PVD are primarily aimed at management of the risk factors for PVD. A prevention program for PVD may include:

  • Smoking cessation, including avoidance of second hand smoke and use of tobacco products
  • Improving your diet by reducing intake of fat, cholesterol, and simple carbohydrates (such as sweets), and increasing amounts of fruits and vegetables
  • Treatment of dyslipidemia (high blood cholesterol levels) with medications as determined by your physician
  • Weight reduction
  • Moderation in drinking alcohol
  • Medications as determined by your physician to reduce your risk for blood clot formation
  • Exercise plan of a minimum of 30 minutes daily
  • Control of diabetes mellitus
  • Control of hypertension (high blood pressure)