Peripheral vascular disease (PVD) is a slow and progressive disorder of the blood vessels. Narrowing, blockage or spasms in a blood vessel can cause PVD.
PVD may affect any blood vessel outside of the heart. This includes the arteries, veins or lymphatic vessels. Organs supplied by these vessels, such as the brain or legs, may not get enough blood flow for healthy function. The legs and feet are most often affected.
Peripheral vascular disease is also called peripheral arterial disease (PAD).
The most common cause of PVD is atherosclerosis. This is the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs. It decreases the oxygen and nutrients sent to the tissue. Blood clots may form on the artery walls. This makes the inner size of the blood vessels even smaller and blocks off major arteries.
Other causes of PVD may include:
Injury to the arms or legs
Irregular anatomy of muscles or ligaments
Infection
People with coronary artery disease (CAD) often also have PVD.
Risk factors that you can’t change include:
Age (higher risk over age 50)
History of heart disease
Male gender
Postmenopausal women
Family history of high cholesterol, high blood pressure, or peripheral vascular disease
Risk factors that may be changed or treated include:
Coronary artery disease
Diabetes
High cholesterol
High blood pressure
Overweight
Physical inactivity
Smoking or use of tobacco products
Those who smoke or have diabetes have the highest risk of complications from PVD. This is because these risk factors cause impaired blood flow.
About half the people diagnosed with PVD have no symptoms. For those with symptoms, the most common first symptom is painful leg cramping that occurs with exercise and is relieved by rest. This is known as intermittent claudication. During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs, depending on the location of the clogged or narrowed artery.
Other symptoms of PVD may include:
Changes in the skin, including decreased skin temperature, or thin, brittle, shiny skin on the legs and feet
Weak pulses in the legs and the feet
Gangrene (dead tissue due to lack of blood flow)
Hair loss on the legs
Impotence
Wounds that won't heal over pressure points, such as heels or ankles
Numbness, weakness, or heaviness in muscles
Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
Paleness when the legs are elevated
Reddish-blue discoloration of the extremities
Restricted mobility
Severe pain when the artery is very narrow or blocked
Thickened, opaque toenails
The symptoms of PVD may look like other conditions. See your healthcare provider for a diagnosis.
Your healthcare provider will ask about your medical history. They will give you a physical exam. You may also have tests such as:
Angiogram. This is an X-ray of the arteries and veins to find blockage or narrowing. This procedure is done by putting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm. It is done using a regular blood pressure cuff and a Doppler ultrasound device. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.
Doppler ultrasound flow studies. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Your doctor may use the Doppler test to measure and assess the flow of blood. Faintness or absence of sound may mean blood flow is blocked.
Magnetic resonance angiography (MRA). This noninvasive test uses a large magnet, radio waves and a computer to make detailed images of organs and other tissues in the body. Your doctor injects a special dye during the procedure. This is done so that blood vessels are more visible.
Treadmill exercise test. For this test, you will walk on a treadmill so your doctor can monitor blood flow during exercise.
Photoplethysmography (PPG). This exam is comparable to the ankle brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements. Your doctor can then compare these measurements to the systolic blood pressure in the arm.
Pulse volume recording (PVR) waveform analysis. Your doctor uses this test to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.
Reactive hyperemia test. This test is similar to an ABI or a treadmill test but used for people who can't walk on a treadmill. While you are lying on your back, your doctor takes comparative blood pressure measurements on the thighs and ankles to determine any decrease between the sites.
The main goals for treatment of PVD are to control the symptoms and halt the progression of the disease. This is important to lower the risk for heart attack, stroke and other problems.
Treatment may include:
Lifestyle changes to control risk factors. These include regular exercise, good nutrition and not smoking
Aggressive treatment of other problems that may worsen PVD. These include diabetes, high blood pressure and high cholesterol.
Medicines to improve blood flow. These include antiplatelet medicines (blood thinners) and medicines that relax the blood vessel walls.
Vascular surgery. A bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery. This is done to reroute the blood flow.
Angioplasty. Your doctor puts a catheter (thin, flexible tube) to create a larger opening in an artery. This is done to increase blood flow. There are several types of angioplasty procedures. They are:
Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.
Atherectomy. The blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter.
Laser angioplasty. A laser is used to "vaporize" the blockage in the artery.
Stent. A tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
An angiogram may be done before angioplasty and vascular surgery.
Complications of PVD most often occur because of decreased or absent blood flow. Such complications may include:
Amputation (loss of a limb)
Poor wound healing
Restricted mobility due to pain or discomfort
Severe pain in the affected extremity
Stroke (3 times more likely in people with PVD)
Following an aggressive treatment plan for PVD can help prevent complications.
To prevent PVD, take steps to manage the risk factors. A prevention program for PVD may include:
Quit smoking, avoid secondhand smoke and don't use any tobacco products
Dietary changes including reduced amounts of fat, cholesterol and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables, low-fat dairy, and lean meats
Treatment of high blood cholesterol with medicine as determined by your healthcare provider
Weight loss
Limiting or quitting alcohol intake
Medicine to reduce your risk for blood clots, as determined by your healthcare provider
Exercise 30 minutes or more daily
Control of diabetes
Control of high blood pressure
To prevent or lessen the progress of PVD, your doctor may advise a prevention plan.