Peripheral Vascular Disease

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The Body’s Vascular System

The body’s vascular system comprises arteries, veins, and lymph vessels. Arteries and veins carry blood throughout the body. Lymph vessels transport infection-fighting lymph. Peripheral vascular disease occurs on the periphery of the heart, affecting the veins and arteries at its extremities. It can also affect the blood vessels that supply blood and oxygen to your arms, intestines, and feet.

Organic PVD causes a change in the structure of your blood vessels. Atherosclerosis is one type, where a build-up of plaque narrows blood vessels. Functional PVD, such as Raynaud’s Disease, causes blood vessels to widen or constrict in response to the environment.

Quick Facts

  • Peripheral vascular disease (PVD) is a circulatory problem affecting the blood vessels outside the heart and brain. It most commonly affects the legs and feet. 
  • Signs of PVD manifest slowly. You may experience cramping, numbness, discoloration, pain, and reduced hair growth.
  • Complications of PVD include tissue death, restricted mobility, wounds that don’t heal, and bone infections. 
  • Depending on the type of PVD, medications, lifestyle modifications, and surgery may be recommended.

Types of PVD

Peripheral Artery Disease: When the accumulation of plaque narrows the arteries, your limbs and organs do not receive adequate oxygen-rich blood. PAD can increase your risk of heart attack, stroke, coronary heart disease, and transient ischemic attack (TIA), a stroke that lasts a few minutes but often precedes a full stroke. 

Deep Vein Thrombosis (DVT): A blood clot develops in a vein located deep in your body. It can occur anywhere in your body but usually forms in your thigh or lower leg. DVT is life-threatening as the clot can break off, travel through your bloodstream, and block blood flow into your lungs. 

Varicose Veins: Varicose veins occur when your veins become twisted and enlarged. They can be observed as bluish or purplish bulges just under the surface of your skin. Rarely, varicose veins may bleed or form blood clots. Ulcers that form on the skin near varicose veins may be extremely painful. 

Chronic Venous Insufficiency: Chronic Venous Insufficiency (CVI) occurs when the valves of the vein do not function properly, restricting blood circulation in the leg veins. Over time, CVI may result in varicose veins, which may bleed and form blood clots. 

Raynaud’s Disease: In people with this disorder, stress or cold temperatures decrease blood flow to the fingers, toes, and knees. Similar symptoms can arise from other causes, such as smoking, certain medications, and connective tissue disease. 

Symptoms

The onset of PVD symptoms is generally slow. 

  • Pain in the arms or legs
  • A warm sensation in the affected part
  • Ankle and foot swelling on the lower leg
  • Weak or absent pulses in the affected limb
  • Numbness or a tingling sensation in the affected limb
  • A gray or bluish tint to the skin 
  • Hair loss or slow hair growth on the legs and feet

Causes and Risk Factors

There are numerous risk factors for PVD:

  • Being over the age of 50
  • Smoking
  • High cholesterol levels 
  • Kidney disease
  • A history of cardiovascular disease
  • High amounts of fat in the blood
  • High amounts of sugar in the blood due to diabetes or insulin resistance
  • Uncontrolled blood pressure 
  • Obesity
  • Drug use

Diagnosis

PVD is diagnosed after an assessment of your medical and family histories, a physical examination, and the diagnostic tests explained below:

Ankle-brachial index: A 10-15 minute test that uses a Doppler ultrasound and a blood pressure device to compare the blood pressure in your ankle to that in your arm. It indicates how well blood is flowing through your limbs. 

Duplex ultrasound: A non-invasive test that uses high-frequency sound waves to view how blood flows through your arteries and veins. 

Arteriogram: A contrast material is injected into an artery and used with an imaging technique, like an X-Ray or CT scan, to identify narrowing blood vessels in your limbs. 

Magnetic resonance angiography (MRA): An MRA is similar to an MRI, with the difference being that an MRA specifically examines the blood vessels to diagnose blockage. 

Treatment

The goal of PVD treatment is to reduce the risk of heart attack or stroke, alleviate symptoms, improve mobility, and avoid complications. Minimally invasive procedures or surgeries may be recommended when blood flow in limbs is blocked or almost blocked, blood clots have formed, or in severe cases where plaque build-up must be removed from an artery.

PVD treatment methods include:

  • Angioplasty and stenting
  • Bypass surgery
  • Atherectomy, which removes plaque by vaporizing it with a laser or shaving it with rotating blades
  • Thrombolysis, which delivers a clot-dissolving drug through an IV line from a visible vein in your arm
  • Thrombectomy, where an incision is made in your blood vessel to remove the clot 

Your doctor may recommend heart-healthy lifestyle changes, such as maintaining a healthy BMI, exercising, controlling blood pressure and diabetes, lowering cholesterol, and giving up smoking.

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