Peripheral Vascular Disease (PVD)

Peripheral vascular disease may be caused when blood vessels become narrowed or blocked by a gradual buildup of fatty plaque (cholesterol) within the vessel wall, which reduces blood flow to the affected areas. Some of the more commonly affected peripheral areas are the arteries in the legs, arms, kidneys and neck. Many patients that have CAD also have PVD.

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

Some of the symptoms you may experience in the affected areas are:

• Claudication (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 (pale, bluish or reddish discoloration)
• Changes in skin temperature, coolness
• 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 my recommendations concerning these factors.

Diabetes: Peripheral Vascular disease is common among those individuals with 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 adopting a daily routine of checking and caring for your feet may reduce your risks from peripheral vascular disease.

Smoking: The risk of peripheral vascular disease is dramatically increased in smokers. When a person stops smoking, regardless of how much he or she may have smoked in the past, their risk of peripheral vascular disease rapidly declines.

Any of the following risk factors may also increase your chance of developing peripheral vascular disease:

• Obesity (being overweight)
• High blood pressure
• A family history of the disease
• Lack of exercise
• Coronary artery disease
• Over age 65
• Hyperlipidemia (high cholesterol)

TREATMENT OPTIONS
There are three basic ways to treat atherosclerotic disease in the periphery: medication, surgery, and endovascular therapy such as a percutaneous transluminal angioplasty (PTA), atherectomy and, stent implantation. The purpose of these treatments is to open the vessel to eliminate or reduce the symptoms you may have.

Medications can be used alone or in combination with one of the above mentioned treatments. While medications do no eliminate the narrowing of arteries, they can help improve the efficiency of the blood flow and reduce symptoms such as chest pain (angina), 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 (catheter) with a small inflatable balloon on the end within the narrowed section of the artery. Inflation of the balloon tip 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 which involve cutting or shaving the plaque to remove it from the arteries, or in some cases, a small latticed metal tube called a stent may be implanted in the artery to help hold the vessel open and improve blood flow.