Intermittent claudication, characterized by pain in leg, experienced while walking, is the classical symptom of peripheral vascular disease. In addition to pain, affected individuals would also experience cramps, weakness and numbness in the area of reduced blood flow [7].
Other symptoms of PVD include the following:

• Development of sores and ulcers in the affected area which do not heal easily
• There is no nail or hair growth in the affected limb
• There is change in the color characterized by bluish tinge or paleness
• Temperature changes also occur; wherein one limb is cold to touch, in comparison to other – a condition known as unilateral dependent rubor.

• Coronary Atherosclerosis

  Peripheral arterial disease and progression of coronary atherosclerosis. J Am Coll Cardiol. 2011 Mar 8. 57(10):1220-5. [Medline]. Nakata S, Yokoi Y, Matsumoto R, et al. [emedicine.medscape.com]

  Peripheral arterial disease (PAD) occurs almost always in the lower extremities. 50 to 75% of patients also have significant cerebral and/or coronary atherosclerosis. [msdmanuals.com]

  The risk factors for PAD mirror those of cerebrovascular and coronary atherosclerosis, including a positive family history, diabetes mellitus, smoking, chronic kidney disease, hypertension, and hyperlipidemia (5,9,10,12,13). [onlinejacc.org]

  Ankle-brachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease. Am J Cardiol. 2000;86615- 618PubMedGoogle ScholarCrossref 37. [jamanetwork.com]

• Difficulty Walking

  If that blockage remains in the peripheral arteries of the legs, it can cause pain, changes in skin color, difficulty walking and sores or ulcers. Total loss of circulation to the legs and feet can cause gangrene and the loss of a limb. [heart.org]

  walking, loss of balance or coordination Sudden severe headache with no known cause Do not try to "wait it out"at home. [webmd.com]

• Toe Pain

  Painful, non-bleeding sores on the feet or toes (most often black) that are slow to heal Paleness of the skin or blue color in the toes or foot (cyanosis) Shiny, tight skin Thick toenails Blood tests may show high cholesterol or diabetes. [medlineplus.gov]

  Painful, non-bleeding sores on the feet or toes (most often black) that are slow to heal Paleness of the skin or blue color in the toes or foot ( cyanosis ) Shiny, tight skin Thick toenails Blood tests may show high cholesterol or diabetes. [mountsinai.org]

• Limb Pain

  Complications of both PVD and PAD include poor wound healing, restricted mobility, limb pain, stroke, heart attack and loss of limb. [nm.org]

  Claudication could be thought of ‘ angina ’ of the limbs Pain is usually relieved by rest As claudication progresses, the distance that a patient can walk reduces. [almostadoctor.co.uk]

• Nocturnal Leg Cramp

  Additional conditions to consider are acute embolism, deep or superficial venous thrombosis, restless legs syndrome, systemic vasculitides, nocturnal leg cramps, muscle or tendon strains, peripheral neuropathy, and arthritides ( Table 1 ). 5 View/Print [aafp.org]

• Dependent Rubor

  rubor; when both limbs are affected this is termed bilateral dependent rubor) Diminished hair and nail growth on affected limb and digits CAUSES & RISK FACTORS Risk factors contributing to PAD are the same as those for atherosclerosis: Smoking - tobacco [westchestermedicalcenter.org]

  When below heart level, the foot may appear dusky red (called dependent rubor). In some patients, elevating the foot causes loss of color and worsens ischemic pain; when the foot is lowered, venous filling is prolonged ( 15 seconds). [msdmanuals.com]

  Dependent rubor, pallor on elevation, absence of hair growth, dystrophic toenails, and cool, dry, fissured skin are signs of vascular insufficiency and should be noted. [care.diabetesjournals.org]

  rubor) Patients with confirmed diagnosis of PAD are at increased risk for subclavian artery stenosis. 43 – 45 An inter-arm blood pressure difference of 15 to 20 mm Hg is abnormal and suggestive of subclavian (or innominate) artery stenosis. [circ.ahajournals.org]

• Visual Field Constriction

  The authors report on 2 patients who were being followed up for possible glaucoma and whose visual field constriction became worse at about the same time as their peripheral vascular symptoms began to increase in severity. [ncbi.nlm.nih.gov]

• Foot Ulcer

  During the follow up, 4·25% of patients of Group B and 35·48% of patients of Group A (P 0·01) showed onset of foot ulceration. [ncbi.nlm.nih.gov]

  ulcers and infected limbs – Chronic wounds, caused by diabetes, which are difficult to heal and can require amputation. [eehealth.org]

  Prevent critical artery occlusion that can lead to foot ulcers, gangrene, and amputation. Prevent heart attacks and strokes. [medicinenet.com]

• Leg Pain

  Approximately 48 hours after the procedure, the patient developed severe, right lower leg pain. On endocrine evaluation, the patient was found to have clinical signs suggesting Paget's disease of bone, which was subsequently confirmed by imaging. [ncbi.nlm.nih.gov]

  You may have leg pain in your calves, thighs, or hips. You may have pain in one or both legs that starts and stops. Most people have pain that starts up when they walk or go upstairs but then goes away when they get off their legs and rest. [healthcare.utah.edu]

  When diagnosing peripheral artery disease, a common condition in people with diabetes, leg pain may arise from intermittent claudication and ischemia. [practicalpainmanagement.com]

  Over-the-counter or prescription pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs may reduce leg pain associated with PVD. [healthcentral.com]

• Calf Pain

  Depending on the location, symptoms may range from dizziness, gait instability and arm pain (subclavian arteries), high blood pressure that is difficult to treat or sudden episodes of difficulty breathing (renal arteries), or calf pain with walking and [heart.ucla.edu]

  Calf pain is the most common location. The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity. [mayoclinic.org]

  pain with exercise Bonaca MP, Creager MA. [medlineplus.gov]

  Peripheral vascular disease; PVD; PAD; Arteriosclerosis obliterans; Blockage of leg arteries; Claudication; Intermittent claudication; Vaso-occlusive disease of the legs; Arterial insufficiency of the legs; Recurrent leg pain and cramping; Calf pain with [mountsinai.org]

• Muscle Cramp

  Symptoms Blockages can restrict blood flow to the muscles, causing muscle cramps, tightness or weakness, especially during activity. In the early stages of PAD, patients may not experience any symptoms. [cardiovascularcoalition.com]

  Stress ABI is used when patients have intermittent claudication (too little blood flow) which can cause severe muscle cramping in the legs, calves, buttocks or arms as the result of exercise. [ufhealthjax.org]

  Effect of rest on pain Effect of body position on pain Other comments Baker cyst, symptomatic Behind knee and down calf Tender to touch, associated swelling Yes None; pain is present at rest None Constant Calf claudication Calf muscles Cramping Yes Subsides [aafp.org]

  The most common symptom of peripheral artery disease (PAD) in the lower extremities is a painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising. [heart.org]

• Restless Legs Syndrome

  Additional conditions to consider are acute embolism, deep or superficial venous thrombosis, restless legs syndrome, systemic vasculitides, nocturnal leg cramps, muscle or tendon strains, peripheral neuropathy, and arthritides ( Table 1 ). 5 View/Print [aafp.org]

• Numbness of the Feet

  People living with diabetes often have neuropathy (nerve damage that can cause numbness in the feet), so they do not feel pain when foot problems occur. [foothealthfacts.org]

• Burning Sensation

  It is an aching or burning sensation in the muscles of the leg that it reliably reproduced after a set walking distance and is relieved with rest. It is not exacerbated by position or present at rest. [physio-pedia.com]

• Cognitive Impairment

  "Statin-related cognitive impairment in the real world: you'll live longer, but you might not like it". JAMA Internal Medicine. 174 (12): 1889. doi:10.1001/jamainternmed.2014.5376. PMID 25347692. [en.wikipedia.org]

The following tests are used for diagnosis of PVD:

• Physical examination: Preliminary physical examination to detect weak pulse, whooshing sound, and signs of poor wound healing in the affected area, would be determined.
• ABI – Ankle Brachial Index: This is one of the most common tests for diagnosing PVD. It measures the blood pressure in the ankle, as well as in the arm. Individuals will be asked to walk on a treadmill, to measure the severity of the symptoms, before and after the exercise [8].
• Ultrasound examination: This method can help evaluate the blood flow, as well as aid in identification of narrowed arteries.
• Blood tests: This is done to determine the presence of underlying conditions, such as diabetes and levels of triglycerides and cholesterol.
• Angiography: Such a type of test, allows in identifying the blocked arteries, and degree of blockage as well.

Treatment of PVD depends on severity of the condition: The following methods would be employed:

• Medications: Medications, such as cilostazol and pentoxifylline, are administered for providing relief from claudication. In addition, medications to lower blood pressure, diabetes and cholesterol are also given.
• Lifestyle modifications: Individuals are also suggested to avoid smoking, alcohol, calorie dense foods, and sedentary lifestyle. All these, significantly increase the chances of developing PVD, and therefore, should be avoided [9].
• Angioplasty: This is a method, which helps in opening the clogged arteries. It is the same procedure, which is employed for opening blocked arteries of the heart.
• Surgery: It is the method of choice, when all other treatments do not bring about the desirable effect. It is known as bypass surgery, wherein a graft bypass is created, with the help of neighboring blood vessels. In some cases, synthetic blood vessels may also be used [10].

Prognosis of peripheral vascular disease depends on the severity of the condition. This is measured with the help of a tool, named as the Ankle brachial pressure index [6]. Individuals with PVD are at an increased risk of developing cardiovascular events, and subsequent mortality. However, if the disease is diagnosed in the preliminary stages, then adopting certain measures can effectively help in controlling the condition.

Development of atherosclerosis is the primary cause of PVD. Although, atherosclerosis majorly affects the heart functioning; it can also significantly affect the blood supply to the limbs, giving rise to PVD. Along with atherosclerosis, other causative factors, such as diabetes mellitus, hypertension, dyslipidemia and obesity, also predispose an individual to develop peripheral vascular disease.

In addition, other risk factors for PVD include emotional stress, extreme cold temperatures, smoking, and operating vibrating tools and machinery [2].

Peripheral vascular disease affects about 10 – 12% of general population. Individuals, above 70 years of age, are more prone to contract this disease condition. It has been estimated that, 20% of individuals at this age develop PVD. It has also been reported that, 1 in every 3 diabetic individuals contract PVD [3].

In the US, PVD strikes about 10 million Americans. In spite of high prevalence rates and associated complications, only 25% of individuals affected by PVD seek medical intervention.

The basic principle involved in the development of peripheral vascular disease, is the narrowing of the arteries, which causes significant reduction in the blood supply to the extremities. Such a kind of phenomenon occurs as a result of several predisposing factors, which include atherosclerosis, smoking, hypertension and diabetes.

It has been reported that, individuals who smoke, are 2 – 3 times at increased risk of developing peripheral arterial disease, concerning the lower extremities. Certain statistics also point towards the fact that, diabetes alone was the major cause of limb amputation in about 70% of cases [4, 5].

Maintaining a healthy lifestyle is the key to prevent development of PVD. The following measures can be adopted, to stay healthy, and keep PVD at bay [11]:

• Regular exercising, for at least 30 minutes a day is a must
• Avoid smoking
• Consuming foods low in cholesterol and fats
• Maintaining healthy weight 
• Keeping blood pressure and diabetes under control

It is a type of circulation disorder, gravely affecting the blood vessels, not including the heart and brain. PVD can turn into a life threatening condition, which can lead to amputation of the affected limb. In more severe conditions, it can also cause death of the individual. Disease conditions, such as atherosclerosis, embolism, stenosis and thrombus formation, can increase the risk of development of PVD [1].

• Definition: Peripheral vascular disease is a condition, characterized by narrowing of the arteries, which causes intermittent claudication to set in. Individuals with underlying disease conditions, and elderly population, are at an increased risk of developing this condition.
• Cause: Atherosclerosis is the major cause of PVD. In addition, several other factors, such as hypertension, diabetes, smoking, obesity and dyslipidemia, increase the chances of contracting PVD.
• Symptoms: Symptoms of PVD include intermittent claudication, characterized by pain in leg during walking. Other symptoms include changes in the coloration, and temperature of the affected skin, followed by development of sores, and ulcers which do not heal readily.
• Diagnosis: Diagnosis is done, through the ankle brachial pressure index, in addition to ultrasound and angiography. Blood tests are also done to determine the underlying disease conditions.
• Treatment: Lifestyle changes and medications form the basis of the treatment regime. Medications to relieve symptoms, and manage the underlying conditions are given. Moreover, leading a healthy lifestyle with regular exercise and healthy diet is also essential.

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