What to know about peripheral vascular disease
If peripheral vascular disease (PVD) occurs only in the arteries, it is called peripheral artery disease (PAD). Most cases of PVD affect the arteries as well, so the terms are often interchangeable.
In this article, we take a close look at PVD, including causes, symptoms, diagnosis, and treatments.
- PVD affects an estimated 1 in 20 Americans over 50 years of age.
- Common risk factors include being over 50, smoking cigarettes, and having high blood pressure or high cholesterol.
- Common symptoms include pain and cramps in the legs, hips, and buttocks.
- According to the Centers for Disease Control and Prevention (CDC), PVD affects men and women equally.
- Arteriosclerosis and atherosclerosis are among the most common causes of PVD.
Types of peripheral vascular disease
There are two main types of PVD:
- Organic PVD results from changes in the blood vessels caused by inflammation, plaque buildup, or tissue damage.
- Functional PVD happens when blood flow decreases in response to something that causes the blood vessels to vary in size, such as brain signals or changes in body temperature. In functional PVD, there is no physical damage to the blood vessels.
PVD commonly affects the legs.
Signs and symptoms of PVD often appear gradually. They occur more commonly in the legs than the in arms because the blood vessels in the legs are further from the heart.
Pains, aches, or cramps while walking are typical symptoms of PVD. However, up to 40 percent of people with PVD or PAD do not experience any leg pain.
Pains, aches, and cramps related to walking, which is known as claudication, might occur in the following areas:
Symptoms of claudication often develop when someone is walking quickly or for long distances. The symptoms typically go away with rest. However, as PVD progresses, symptoms can get worse and become more frequent. Leg pain and fatigue may persist even while resting.
Other symptoms of PVD include:
- leg cramps when lying down
- pale or reddish-blue legs or arms
- hair loss on the legs
- skin that is cool to the touch
- thin, pale, or shiny skin on the legs and feet
- slow-healing wounds and ulcers
- cold, burning, or numb toes
- thickened toenails
- slow or absent pulse in the feet
- heavy or numb sensations in the muscles
- wasting away of the muscle (atrophy)
Causes of PVD vary and depend on the type a person has.
Causes of organic PVD
Arteriosclerosis, which is caused by changes in the structure of the blood vessels, is a common cause of organic PVD.
Atherosclerosis, which is a specific type of arteriosclerosis, occurs when plaque (fats and other substances) build up in the blood vessels. Atherosclerosis can restrict blood flow, and if left untreated, can cause clots. Clots block the arteries and cause loss of limbs or organ damage.
Common risk factors for atherosclerosis include:
- high blood pressure (hypertension)
- high cholesterol or triglycerides
- inflammation from arthritis, lupus, or other conditions
- insulin resistance
The following conditions may cause structural changes in the blood vessels:
- Buerger's disease
- chronic venous insufficiency
- deep vein thrombosis (DVT)
- Raynaud's syndrome
- varicose veins
Injury, inflammation, or infection in the blood vessels may also cause structural changes in the blood vessels.
Causes of functional PVD
Functional PVD occurs when blood vessels have an increased response to brain signals and environmental factors. Common causes of this include:
- cold temperatures
- drug use
- feeling stressed
- using machines or tools that cause the body to vibrate
Smokers and people over the age of 50 are at an increased risk of developing PVD.
In general, the risk factors for PVD are similar to those for arteriosclerosis. They include:
- Age. People aged 50 years and over are more likely to get PVD and PAD.
- Being overweight or obese increases risk of arteriosclerosis, PVD, and other cardiovascular conditions.
- Lifestyle choices. People who smoke, use drugs, avoid exercise, or have an unhealthful diet are more likely to get PVD.
- Medical and family history. PVD risk rises for people who have a history of cerebrovascular disease or stroke. Those with a family history of high cholesterol, hypertension, or PVD are also at higher risk.
- Other medical conditions. People with high cholesterol, hypertension, heart disease, or diabetes are at an increased risk of developing PVD.
- Race and ethnicity. African American people tend to develop PVD more frequently.
If a person suspects they have PVD, it is essential that they see a doctor. Early diagnosis and treatment can improve the outlook for the disease and prevent severe complications from occurring.
A doctor will diagnose PVD by:
- Taking a full medical and family history, which includes details of lifestyle, diet, and medication use.
- Performing a physical examination, which includes checking the skin temperature, appearance, and the presence of pulses in the legs and feet.
They may also order tests to confirm a diagnosis or rule out other conditions. Several other disorders can mimic the symptoms of PVD and PAD.
Diagnostic tests used to diagnose PVD include:
- Angiography. Angiography involves injecting dye into the arteries to identify a clogged or blocked artery.
- Ankle-brachial index (ABI). This non-invasive test measures blood pressure in the ankles. The doctor then compares this reading to blood pressure readings in the arms. A doctor will take measurements after rest and physical activity. Lower blood pressure in the legs suggests a blockage.
- Blood tests. Although blood tests alone cannot diagnose PVD, they can help a doctor check for the presence of conditions that can increase a person's risk of developing PVD, such as diabetes and high cholesterol.
- Computerized tomography angiography (CTA). A CTA imaging test shows the doctor an image of the blood vessels, including areas that have narrowed or become blocked.
- Magnetic resonance angiography (MRA). Similar to a CTA, magnetic resonance angiography highlights blood vessel blockages.
- Ultrasound. Using sound waves, an ultrasound allows the doctor to see blood circulation through the arteries and veins.
Effective PVD treatment aims to slow or stop disease progression, manage pain and other symptoms, and reduce the risk of serious complications.
PVD treatment plans usually involve lifestyle changes. Some people may also require medication, and severe cases may require surgical treatment.
Lifestyle changes include:
- engaging in regular exercise, including walking
- eating a balanced diet
- losing weight if necessary
- quitting smoking
Medications to treat PVD include:
- cilostazol to reduce claudication
- pentoxifylline to treat muscle pain
- clopidogrel or aspirin to stop blood clotting
Co-occurring conditions may also require medicines to keep symptoms under control. For example, some people may need:
- statins (such as atorvastatin and simvastatin) to reduce high cholesterol
- angiotensin-converting enzyme (ACE) inhibitors for hypertension
- metformin or other diabetes medications to manage blood sugar
People with severe PVD might require surgery to widen arteries or bypass blockages. Surgical options are:
- Angioplasty. This involves inserting a catheter that is fitted with a balloon into the damaged artery and then inflating the balloon to widen the artery. Sometimes, the doctor will place a small tube (stent) in the artery to keep it open.
- Vascular bypass surgery. Also known as a vascular graft, this procedure involves reconnecting blood vessels to bypass a narrow or blocked part of a vessel. It allows blood to flow more easily from one area to another.
PVD can increase the risk of a heart attack.
If PVD is left undiagnosed and untreated, it can cause severe or life-threatening complications such as:
- gangrene (tissue death), which can require amputation of the affected limb
- heart attack or stroke
- severe pain that restricts mobility
- slow-healing wounds
- potentially fatal infections of the bones and blood
A person can reduce their risk of developing PVD by:
- quitting smoking, or not starting
- engaging in at least 150 minutes of cardiovascular activity, such as walking or running, each week
- eating a balanced diet
- maintaining a healthy body weight
- managing blood sugar, cholesterol, and blood pressure levels
When diagnosed early, PVD is often easily treated with lifestyle modifications and medications.
A doctor can monitor a person's improvement by measuring the distance they can walk without claudication. If treatments are effective, people should be able to gradually walk longer distances without pain.
Early intervention may prevent the condition from progressing and can help to avoid complications. Anyone experiencing any of the symptoms of PVD should see a doctor.
The sudden development of pale, cold, and aching limbs with loss of pulses is a medical emergency and requires immediate treatment.