End stage peripheral vascular disease may put people at risk of limb amputation or life threatening complications, such as strokes and gangrene. Treatment typically involves surgery.

Peripheral vascular disease (PVD), also known as peripheral artery disease, is a condition that restricts blood flow to a person’s limbs and other body parts. It can affect any blood vessel outside the heart. However, it most commonly affects the legs. Some organs, such as the brain, may not get enough blood flow to work properly.

The most severe forms, or end stages, of PVD, can lead to critical limb ischemia (CLI) and acute limb ischemia (ALI). People with CLI or ALI are at risk of limb loss or gangrene.

This article discusses PVD and how the condition progresses to its end stage. It also discusses the causes, symptoms, treatments, and complications of end stage PVD.

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PVD affects 40–45 million Americans.

Atherosclerosis — the buildup of cholesterol and fat, or plaque, in a person’s arteries — is the most common cause of PVD. This buildup can reduce or block the blood flow through a person’s blood vessels, leading to pain and cramping.

Other causes of PVD include:

PVD tends to worsen over time, with symptoms progressing through different stages.

People in the early stages of PVD may experience no symptoms. As PVD progresses, symptoms typically worsen.

There are two main classification systems for describing the stages and symptoms of PVD — the Rutherford and Fontaine systems:

  • Rutherford Category 0 or Fontaine Stage 1: At this stage, a person with PVD has no symptoms.
  • Rutherford Categories 1–3 or Fontaine Stages 2a and 2b: PVD symptoms include mild to severe claudication. “Claudication” is the medical term for pain, cramping, or fatigue in a person’s legs after sustained exercise or walking. The pain stops after a person stands still for a few minutes.
  • Rutherford Category 4 or Fontaine Stage 3: People have ischemic resting pain — severe pain in their legs and feet when they are resting. They may also have sores on their legs and feet that do not heal. Ischemic resting pain is an indicator of CLI.
  • Rutherford Categories 5 and 6 or Fontaine Stage 4: In these end stages of PVD, people may have some minor tissue loss and ulcers forming on the skin of their legs. They may also have gangrene, a serious condition in which the body tissues start to die as a result of a lack of blood supply.

Other symptoms in one or both legs, such as the following, may indicate earlier stages of PVD:

  • muscle atrophy, or leg weakness
  • leg numbness, pain, or heaviness when walking or climbing stairs
  • leg hair loss
  • smooth, shiny, leg skin
  • a lack of toenail growth
  • leg skin that feels cool to the touch
  • weak pulse or no pulse in the feet
  • cold or numbness in the toes
  • erectile dysfunction, especially among those who have diabetes

The most common cause of end stage PVD is worsening atherosclerosis. This is when plaque buildup blocks or narrows a person’s blood vessels, causing the loss of some or all blood circulation to the limbs.

If the plaque buildup entirely blocks blood circulation to a person’s limbs, it can cause end stage PVD.

Factors that raise a person’s risk of PVD include:

Symptoms of end stage PVD include the symptoms of CLI, such as:

  • ischemic resting pain
  • tissue loss
  • gangrene

End stage PVD symptoms also include symptoms of ALI, such as:

  • leg pain
  • pallor, which means a person’s skin looks lighter than their typical complexion
  • lack of a pulse in the legs
  • poikilothermia, or cold legs
  • paresthesias, or a tingling or prickling “pins and needles” sensation in the legs
  • leg paralysis, with a loss of sensation and ability to move the legs, in more severe cases of PVD

If a person believes they may be experiencing the symptoms of CLI or ALI, they should immediately seek medical attention. Doctors classify CLI and ALI as medical emergencies. People with CLI or ALI need an emergency consultation with a doctor to avoid limb amputation.

Doctors typically diagnose CLI if a person has been experiencing symptoms for at least 2 weeks. If symptoms have been present for less time, then doctors will generally consider the condition ALI.

Doctors consider the following when diagnosing PVD:

  • a person’s risk factors
  • the results of physical exams
  • a person’s description of their symptoms

If PVD is end stage, doctors will typically use surgery to treat CLI or leg pain.

Doctors can use endovascular surgery to improve the blood flow to a person’s leg. During this type of surgery, doctors inject a long, thin, flexible tube called a catheter through a person’s skin into their blood vessels, or arteries. They then use the catheter to operate on the blood vessels.

PVD may have life threatening complications. Blockages in a person’s blood vessels or arteries can affect other areas of their body, such as their heart and brain. They may then develop other forms of cardiovascular disease, leading to:

Other possible complications of PVD include:

Around 50% of people with end stage PVD have a life expectancy of 5 years from the time of diagnosis.

A buildup of plaque in a person’s blood vessels can lead to end stage PVD. This condition tends to develop over time with worsening symptoms.

Without treatment, PVD can cause serious or life threatening complications.

Doctors can treat end stage PVD with surgery. Most risks for PVD involve lifestyle factors. Lifestyle strategies such as quitting smoking, making efforts to reach or maintain a moderate weight, and eating a healthy and balanced diet can help reduce the risk of PVD progressing to end stage.