Table of Contents
What is Peripheral Vascular Disease
ATHEROSCLEROSIS that affects the peripheral arteries, notably those in the legs. ATHEROSCLEROTIC PLAQUE infiltrates the inner wall of the arteries, the intima. This causes the intima to thicken and stiffen, restricting the FLEXIBILITY of the ARTERY as well as narrowing the passage for BLOOD (arterial lumen). Peripheral Vascular Disease can affect the largest to the smallest of the peripheral arteries and is the cause of INTERMITTENT CLAUDICATION as well as often an underlying factor in ERECTILE DYSFUNCTION. NEUROPATHY of DIABETES can severely exacerbate Peripheral Vascular Disease, resulting in restricted circulation and limb ischemia (oxygen deprivation) that can cause tissue death (GANGRENE). PVD due to diabetes is a leading cause of limb amputation. PVD also may contribute to HYPERTENSION (high BLOOD PRESSURE).
Symptoms of Peripheral Vascular Disease and Diagnostic Path
PVD often has firmly established itself by the time symptoms manifest. Intermittent claudication-PAIN with walking-is the primary symptom of Peripheral Vascular Disease affecting the lower extremities. Leg or foot pain at rest, with coolness and pallor or CYANOSIS of the limb, suggests embolism (clot or atherosclerotic fragment blocking the flow of blood). Other symptoms may include lack of sensation (PARESTHESIA) or inability to move the limb (PARALYSIS), and wounds that do not heal. In severe PVD there is sometimes a mottled appearance to the SKIN. The doctor may be unable to feel a PULSE in the leg or foot, depending on the level of the occlusion or embolism. The diagnostic path often includes Doppler ULTRASOUND examination, and sometimes MAGNETIC RESONANCE IMAGING (MRI), of the legs.
Peripheral Vascular Disease Treatment Options and Outlook
The primary thrust of treatment when symptoms are present is ANTICOAGULATION THERAPY, which may include intravenous heparin when the doctor suspects an embolism. For symptoms such as intermittent claudication or rest ischemia, the treatment is typically the oral anticoagulant warfarin or antiplatelet agents such as cilostazol to reduce the risk for clot formation. A program of progressive walking improves blood flow in the legs as well as strengthens the leg muscles so they can provide additional support for the blood vessels. Weight loss reduces pressure on the arteries. The treatment regimen often includes lipid-lowering medications in conjunction with lifestyle modifications to lower blood lipid levels, which are usually elevated in Peripheral Vascular Disease. Lifestyle changes include daily physical exercise such as walking, nutritious EATING HABITS, and SMOKING CESSATION. When symptoms fail to improve with these therapeutic measures, the doctor may consider ATHERECTOMY, an OPERATION to remove segments of atherosclerotic plaque from the arterial walls. Many people who have intermittent claudication benefit from wearing support stockings, which are tight against the legs to help support the blood vessels.
PVD is a progressive condition closely linked with CORONARY ARTERY DISEASE (CAD). Therapeutic approaches, which must include lifestyle modifications to be successful, often can slow its progress.
Risk Factors and Preventive Measures
The risk factors for Peripheral Vascular Disease include smoking, other atherosclerotic disease processes such as CAD, diabetes, and HYPERLIPIDEMIA. Controlling or eliminating these factors reduces the risk for PVD. Once PVD shows symptoms, then the most effective approach is aggressive management to prevent the condition from worsening.