Peripheral vascular disease (PVD), or peripheral arterial disease (PAD), is a medical term referring to some vascular diseases affecting the peripheral blood vessels (specifically the arteries). Vascular disease occurs mainly in the legs, but may occur in the stomach or kidney vessels, as well. It is defined by a narrowing of the lumen of these arteries that develop cholesterol deposits in the inner wall of the artery.

These deposits are called atherosclerotic plaques. PVD affects both large and small vessels (macrovascular or microvascular), but the main presentation is usually due to large vessel involvement. The major risk, in this case, is decreasing blood flow and tissue perfusion in the tissues supplied by the affected artery.

The plaque can rupture, leading to intravascular thrombosis and embolism. Other than this organic form of the disease, there is a functional form occurring with no structural changes in the arteries, but there is an intermittent spasm (severe constriction) in the arteries leading to ischemia (lowered tissue oxygenation, nutrition and increased waste products accumulation in the tissue due to decreased blood supply).

This functional form usually leads to short-term attacks, and may occur in many forms. An example of this form is Raynaud’s disease, where the spasm is triggered by cold temperature, smoking or emotional stress.Although PVD has a very diverse etiology and the mechanism is not clear, PVD is known to be common with diabetes as a major risk factor, especially if associated with smoking.

Smoking and Risk Factors

Smoking is an aggravating risk factor. The metabolic changes made by these two factors in the blood, such as hypertension, dyslipidemia and hypercholesterolemia, are the leading causes of atherosclerosis, coronary artery disease and PVD. Other risk factors are family history of PVD, old age, high levels of homocysteine and C-reactive protein CRP in the blood.In mild cases, PVD may remain asymptomatic.

However, it is a progressive disease and with time, the narrowing will be more severe and persistent, leading to serious manifestations. A patient with PVD is typically presented with 5 Ps in his affected limb (Pulselessness, Parasthesia (”numbness”), Pallor, Pain “intermittent claudication or cramping” and even Paralysis). Other symptoms may be vascular ulcers (”Painful leg sores showing no healing with time”), hair loss in the affected leg, changes in its toenail and recurrent infections with delayed healing.

Patients with PVD have a risk for, what is called, critical limb ischemia (CLI), in which the blood supply is not enough to maintain vital tissues, leading to their death and putrefaction (gangrene). Also having advanced atherosclerosis complicated by PVD means that the patient is also at risk for developing other atherosclerotic complications such as heart failure, coronary artery disease and stroke.

Diagnose Peripheral Vascular Disease

Diagnosis of PVD requires proper physical examination and laboratory tests with good differential diagnosis. After physical examination for PVD signs, the following tests can be useful: Ankle-Brachial Index (ABI) is measured by comparing the blood pressure in the ankle and the arm.

Special Ultrasonography such as Doppler ultrasound and duplex scanning can be useful in assessment of the blood flow and locating any narrowed or blocked vessels.

Angiography using special contrast materials (dyes) could be very useful.

Magnetic Resonance Angiography (MRA).

Computed Tomography Angiography (CTA).

CTA or Catheter angiography is an invasive procedure, allowing both diagnosis and treatment in the same time. A catheter is inserted and guided through an artery in the groin to reach the affected area for visualization, and at the same time allowing widening by angioplasty techniques, or applying medications in the affected area, to enhance the blood flow.

Treat PVD Early

Treatment of PVD requires proper diagnosis and management of the causes, risk factors, manifestations and complications, if present. Medications should be given to control diabetes, hypertension, hypercholesterolemia and dyslipidemia. Anti-coagulants and peripheral vasodilators are useful in improving the blood flow.

In some cases, angioplasty or surgery may be required to improve the blood flow. In angioplasty a small catheter is inserted in the artery and a small balloon at its tip is inflated to reopen the artery. Sometimes a stent insertion (small mesh framework) into the vessel is required to keep it open and prevent future blockage.

Alternatively, PVD can be treated by bypass surgery, utilizing a graft bypass using a vessel taken from another part of the body. Doctors also recommend following a supervised exercise program to improve the blood flow and to increase the limb capacity, in order to walk and function with less leg cramps and complications.

Finally, strict, preventive measures should be taken. Simple lifestyle modifications can make a difference. Stop smoking, control diabetes, lower blood cholesterol, control hypertension, start eating healthy foods and perform mild, regular exercise as recommended by your primary care provider. Mild, regular exercise is proven to be the best measure you can take, in order to control diabetes, atherosclerosis and cardiovascular disorders.

Patients should also mind proper foot care to avoid developing vascular ulcers and infections. Regular foot cleansing and the use of skin moisturizers are important to maintain healthy feet.

Injuries that may lead to infections should be avoided. Also, wearing well fitting shoes with thick protective socks will prevent foot trauma and infection, which can be dangerous in a patient with PVD. Patients should be instructed to take care during trimming nails, avoid walking barefoot and advise their primary care doctor, in case of any trauma, sores or infections.

Proper medical treatment is vital, in order to avoid PVD complications

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