Peripheral Vascular Disease
(PVD; PAD; Arteriosclerosis Obliterans; Atherosclerosis; Peripheral Vascular Arterial Disease)
Peripheral vascular disease (PVD) is a general term for disease of any blood vessel that is not part of the heart or brain. The arterial form, usually referred to as PAD, is caused by deposits of fatty material (atheroma) in arteries of the legs. Since arteries carry oxygen-rich blood to the cells of the body, restriction of this blood flow can cause bodily organs to fail.
This is a potentially serious condition that requires care from your doctor. The sooner PAD is treated, the more favorable the outcome. If you suspect you have this condition, contact your doctor.
PAD is usually caused by a gradual buildup of plaque within the arteries ( atherosclerosis]]> ). Other causes include blood clots or embolisms, congenital heart disease, and inflammation of the blood vessels (vasculitis).
PAD can be hereditary. More commonly, you may get PAD if you are overweight or ]]>obese]]> , or have ]]>high blood pressure]]> , ]]>diabetes]]> , or ]]>high cholesterol]]> . Unhealthy lifestyle choices such as smoking, eating a high-fat diet, and not exercising enough frequently lead to PAD.
The following factors increase your chance of developing PAD. If you have any of these risk factors, discuss them with your doctor:
Symptoms of PAD are related to the organ or part of the body deprived of adequate circulation. This includes:
- Claudication—pain, fatigue, aching, tightness, weakness, cramping or tingling in the leg(s) brought on by exercise that goes away when resting, in mild disease
- Numbness and pain of the legs or feet at rest in more severe disease
- Cold hands, legs, or feet
- Loss of hair on the legs and/or feet at night
- Paleness or blueness of the legs
- Weak or absent pulse in the leg
- Sores, ulcer, or infection of the feet and legs that heal slowly
- Erectile dysfunction]]>
- Swelling in lower extremities
- Muscle atrophy
Bones and Vasculature of the Foot
Your doctor will ask about your symptoms and medical history, and perform a physical exam . Tests may include the following:
- Checking the strength of the pulse in the leg arteries
- Listening for a whooshing sound in a leg artery or the abdomen using a stethoscope
- Checking blood pressure at various points in the leg and comparing it to the normal arm blood pressure
- Blood tests for blood lipids, homocysteine, fasting blood sugar, hemoglobin A1C, oxidative stress marker (eg 8-iso-PGF 2 alpha)
- Treadmill test
- Ultrasound and doppler analysis]]> of the arteries, especially the carotid arteries in the neck which supply the brain with blood
- ]]>Electrocardiogram (ECG, EKG)]]> —a test that records the heart's activity by measuring electrical currents through the heart muscle
- ]]>Angiography]]> of the arteries in the legs—x-rays of blood vessels that have been injected with a dye
- ]]>MRI]]> —a test that uses magnetic waves to make pictures of the blood vessels
Early treatment can slow or stop the advancement of the disease. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
- Smoking]]> cessation
- ]]>Diabetes]]> control
- ]]>Blood pressure]]> control
- Increased ]]>physical activity]]> (eg, walking program)
- ]]>Weight loss]]> if overweight
- Low-saturated fat, low-cholesterol ]]>diet]]>
(very important for people with diabetes)
- Shoes that fit properly
- Proper treatment of all foot injuries—healing is slowed when circulation is poor, and the risk of infection is higher
- Antiplatelet agent, such as ]]>aspirin]]> and ]]>clopidogrel]]> to thin your blood
- Medicines to reduce leg pain (eg, ]]>pentoxifylline]]> )
- Medicines to help improve walking distance ( ]]>cilostazol]]> , ]]>simvastatin]]> )
- Cholesterol-lowering agents ( ]]>statins]]> )
- Medicines to enlarge or dilate the affected arteries
Surgery to open up narrowed arteries is performed in severe cases.
- ]]>Endarterectomy]]> —the lining of the artery is removed
- Bypass surgery—a vein from another part of the body or a synthetic graft replaces the vessel
If you are diagnosed with PAD, follow your doctor's instructions .
Canadian Society for Vascular Surgery
Heart and Stroke Foundation of Canada
American College of Cardiology and American Heart Association 2005 Practice Guidelines for the management of patients with peripheral arterial disease. Circulation . 2006;113:e463-654.
Arteriosclerosis of the extremities. US National Library of Medicine, Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000170.htm . Updated May 2009. Accessed July 24, 2009.
Gey DC, Lesho EP, Manngold J. Management of Peripheral Arterial Disease. Am Fam Physician . 2004;69:525-532.
Lumsden AB, Rice TW. Medical management of peripheral arterial disease:a therapeutic algorithm. J Endovasc Ther . 2006;13(suppl 2)II19-29.
Mahmud E, Cavendish JJ, Salami A. Current treatment of peripheral arterial disease: role of percutaneous interventional therapies. J Am Coll Cardiol 2007;50:473-490.
Peripheral arterial disease. American Family Physician website. Available at: http://www.aafp.org/afp/20040201/533ph.html . Published February 2004. Accessed August 9, 2005.
Peripheral vascular disease. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4692 . Accessed August 9, 2005.
Peripheral arterial disease (PAD). Mayo Clinic website. Available at: http://www.mayoclinic.com/health/peripheral-arterial-disease/DS00537 . Updated June 2009. Accessed July 24, 2009.
Peripheral arterial disease: what is it?. Vascular Disease Foundation website. Available at: http://www.vdf.org/diseaseinfo/pad/ . Updated July 2009. Accessed July 24, 2009.
Regensteiner JG, Stewart KJ. Established and evolving medical therapies for claudication in patients with peripheral arterial disease. Nat Clin Pract Cardiovasc Med . 2006;3: 604-610.
Last reviewed September 2009 by ]]>David N. Smith, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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