Peripheral vascular disease (PVD) and intervention

Heart disease and stroke often are caused by a decrease or cessation of blood flow to the heart and brain. Peripheral vascular disease (PVD) describes diseases of the blood vessels outside of the heart or brain, often those that carry blood to the legs, arms, neck or kidneys. PVD often is caused when blood vessels become narrowed or blocked by a gradual buildup of the fatty plaque known as cholesterol within the vessel wall. This reduces blood flow to the affected areas. Many patients who have coronary artery disease also have PVD.

As the internal lining of the artery thickens from the build-up of artherosclerotic plaque, the blood vessel becomes increasingly constricted and blood flow diminishes. Therefore, the symptoms you may experience depend on which artery is affected and how severely the blood flow is reduced.

Symptoms of PVD

Symptoms of PVD often can be felt in the areas of the body that are not receiving the normal flow of blood. Symptoms can include:

  • Claudication, which is a dull, cramping pain in hips, thighs or calf muscle during exertion or exercise
  • Buttock pain
  • Numbness or tingling in leg, foot or toes
  • Changes in skin color, including pale, bluish or reddish discoloration
  • Changes in skin temperature
  • Impotence
  • Infections or sores that do not heal
  • Ulceration or gangrene
  • Uncontrolled hypertension (high blood pressure)
  • Kidney failure
  • Blurred vision or temporary blindness

PVD risk factors

Clinical studies have identified factors that increase the risk of peripheral vascular disease. Some of the factors cannot be changed, while others can be managed to greatly reduce your risk of the disease. Remember to follow your doctor’s recommendations about addressing these factors.

Diabetes: PVD is common among people who have diabetes. This correlation is due to complications of the disease, which may cause damage to the blood vessels of the legs and feet. Blood flow to the feet must be carefully monitored as damage to the nerves or a foot injury may go unnoticed until an infection or sore develops. A healthy diet and a daily routine of checking and caring for your feet may reduce your risks from peripheral vascular disease.

Smoking: Smokers have a dramatically elevated risk of PVD. No matter how much someone may have smoked in the past, quitting smoking causes the risk of PVD to rapidly decline.

Other PVD risk factors include:

  • Obesity
  • High blood pressure
  • A family history of PVD
  • Lack of exercise
  • Coronary artery disease
  • Over age 65
  • High cholesterol

Treatment options

There are three basic ways to treat PVD: Medication, surgery and endovascular therapies such as percutaneous transluminal angioplasty (PTA), atherectomy and stent implantation. The purpose of these treatments is to open any impacted vessel to eliminate or reduce symptoms you may have.

Medications can be used alone or in combination with one of the above treatments. While medications do not eliminate the narrowing of arteries, they can help improve the efficiency of the blood flow and reduce symptoms such as chest and leg pain, claudication and hypertension.

Angioplasty or percutaneous transluminal angioplasty (PTA) is a technique used to reduce the narrowing in your artery without surgery. The basic idea of angioplasty is to position a thin tube known as a catheter outfitted with a small inflatable balloon within the narrowed section of the artery. Inflating the balloon opens the narrowed artery by splitting and compressing the plaque and slightly stretching the wall of the artery. The balloon is then deflated and removed from the artery.

There are other minimally invasive procedures that involve cutting or shaving the plaque to remove it from the arteries. In some cases, a small, latticed metal tube called a stent may be implanted in the artery to help hold the blood vessel open and improve blood flow.