Peripheral Vascular Disease
Peripheral vascular disease, also known as peripheral arterial disease, or PVD, is a condition of the blood vessels that leads to narrowing and hardening of the arteries that supply the legs and feet. Because it decreases blood flow, PVD can injure nerves and other tissues.
Causes & Risk Factors
PVD is caused by a condition known as atherosclerosis, in which fatty material collects along the walls of arteries. Over time, the fatty material thickens, hardens and forms calcium deposits, eventually blocking the arteries. The arteries can become narrower and stiffer, so they cannot dilate to allow greater blood flow when needed. As a result of PVD, a patient's leg muscles cannot get enough blood and oxygen when they are working harder. Eventually, legs may not be able to receive enough blood and oxygen at all, even when the muscles are resting.
PVD is a common disorder, usually affecting men over age 50. People are at higher risk of PVD if they have a history of diabetes, abnormal cholesterol, heart disease, high blood pressure, kidney disease, smoking or stroke.
Symptoms & Warning Signs
Classic symptoms of PVD include pain, achiness, fatigue, burning or discomfort in the muscles of your feet, calves or thighs. Commonly, these symptoms start during exercise and go away after several minutes of rest. In the early stages of PVD, the symptoms may be present only during strenuous exercise, such as walking uphill, walking faster or walking for longer distances. Over time, however, the symptoms can occur more quickly and with less exercise.
People with PVD may feel numbness in their legs or feet when resting. They may also feel cool to the touch, sometimes with the skin appearing pale. Severe cases of PVD may cause pain or tingling in the foot or toes, sometimes so severe that even the weight of clothes or bed sheets can cause discomfort. Pain may also be worse when the leg is elevated, improving when the person dangles their legs over the side of the bed.
Contact a doctor If you have any new sores or ulcers; signs of infection, such as fever or redness; a leg or foot that becomes cool to the touch, pale, blue or numb; chest pain or shortness of breath with leg pain; leg pain that does not go away, even when you are not walking or moving; or legs that are red, hot or swollen.
Tests & Diagnosis
Initial tests for PVD include simple physical examinations. In cases of PVD, a health professional may find weak or absent pulse in the limb, loss of hair on the legs or feet, a whooshing sound with the stethoscope over the artery and/or decreased blood pressure in the affected limb. More severe cases of PVD may present themselves in the form of paleness of the skin or blue color in the toes or foot; calf muscles that shrink; hair loss over the toes and feet; thick toenails; shiny, tight skin; and black, painful, non-bleeding ulcers on the feet or toes that are slow to heal.
To confirm the diagnosis, a doctor may perform a blood test. Results in PVD patients commonly show high cholesterol or diabetes. Doctors may also check the blood pressure in the arms and legs for comparison to the affected limb. An arteriography, which uses X-rays and a special dye to see the arteries in any affected limbs, may also be performed. Alternate tests include CT scans and ultrasounds.
Prevention & Treatment
Most treatment for PVD involves lifestyle changes, such as balancing exercise with rest, stopping smoking, caring for feet and eating a low-cholesterol, low-fat diet. Doctors may prescribe medication to control the disorder, such as aspirin or Plavix, Cilostazol, pain relievers or cholesterol inhibitors. Do not begin or cease taking these medications until you are given direct written permission from your health care provider.
In cases of PVD where the condition is affecting a patient's ability to work or pursue essential activities, doctors may perform surgery, such as a peripheral artery bypass of the leg, or an angioplasty and stent placement of the peripheral arteries. In extremely severe cases, the limb may need to be amputated.