Peripheral Vascular Disease

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.

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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