Edit concept Question Editor Create issue ticket

Peripheral Vascular Disease

PVD

Peripheral vascular disease, abbreviated as PVD, is a condition characterized by obstruction of large arteries, causing the blood supply to reduce significantly. Such a type of condition is also referred to as Peripheral arterial disease.


Presentation

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 Artery Disease
  • KEYWORDS: Cardiac dysfunction; Coronary artery disease; Perioperative ischemia; Peripheral arterial disease; Vascular disease[ncbi.nlm.nih.gov]
  • However, macrovascular complications (coronary artery disease, stroke and peripheral vessel disease) are rare, as these subjects are younger, leaner and have lower cholesterol levels.[ncbi.nlm.nih.gov]
  • We also recorded risk factors such as hypertension, diabetes, total cholesterol, serum white blood cells, serum creatinine, body mass index, blood pressure, statin use, current smoking status, coronary artery disease, cerebral vascular accident, and chronic[ncbi.nlm.nih.gov]
  • As PVD is a coronary artery disease risk equivalent, screening and diagnosis may change lipid management in preventive cardiovascular risk assessment in patients with SLE.[ncbi.nlm.nih.gov]
Lower Extremity Pain
  • Over the next 36 hours, the patient developed severe bilateral lower extremity pain followed by extensive livedo reticularis over lower extremities, elevated creatine kinase levels, myoglobinuria, and a rise in serum creatinine to 1.5 mg/dL (133 micromol[ncbi.nlm.nih.gov]
Limb Pain
  • 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]
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.[mountsinai.org]
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]
  • BACKGROUND: Diabetic foot ulcer is one of the chronic complications of diabetes mellitus (DM) with 25% of patients with diabetes developing a foot ulcer during their lifetime leading to amputation.[ncbi.nlm.nih.gov]
  • The article provides background on the pathophysiology of diabetic foot ulcers as well as a review of the literature on the therapeutic use of pentoxifylline for treating this disorder.[ncbi.nlm.nih.gov]
  • ulcers and infected limbs – Chronic wounds, caused by diabetes, which are difficult to heal and can require amputation.[eehealth.org]
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]
  • Loyola offers numerous treatment options for peripheral vascular disease, enabling you to reduce your leg pain and resume normal physical activity.[loyolamedicine.org]
  • You may have blocked arteries with claudication, which is leg pain while walking or exercising. The pain tends to first appear as a cramping in the calf. You may have blocked arteries with severe problems.[uvmhealth.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]
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]
  • 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]
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]

Workup

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

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

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.

Etiology

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].

Epidemiology

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.

Sex distribution
Age distribution

Pathophysiology

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].

Prevention

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

Summary

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].

Patient Information

  • 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.

References

Article

  1. Chen CC, Hung KC, Hsieh IC, Wen MS. Association between peripheral vascular disease indexes and the numbers of vessels obstructed in patients with coronary artery disease. Am J Med Sci. Jan 2012;343(1):52-5.
  2. Meller SM, Stilp E, Walker CN, Mena-Hurtado C. The link between vasculogenic erectile dysfunction, coronary artery disease, and peripheral artery disease: role of metabolic factors and endovascular therapy. J Invasive Cardiol. Jun 2013;25(6):313-9.
  3. Novo S. Classification, epidemiology, risk factors, and natural history of peripheral arterial disease. Diabetes Obes Metab 2002; 4 Suppl 2:S1.
  4. Hedin U, Wahlberg E. Gene therapy and vascular disease: potential applications in vascular surgery. Eur J Vasc Endovasc Surg. Feb 1997;13(2):101-11.
  5. Golomb BA, Dang TT, Criqui MH. Peripheral arterial disease: morbidity and mortality implications. Circulation 2006; 114:688.
  6. Allison MA, Cushman M, Solomon C, et al. Ethnicity and risk factors for change in the ankle-brachial index: the Multi-Ethnic Study of Atherosclerosis. J Vasc Surg 2009; 50:1049.
  7. McDermott MM, Greenland P, Liu K, et al. Leg symptoms in peripheral arterial disease: associated clinical characteristics and functional impairment. JAMA 2001; 286:1599.
  8. Mahé G, Le Faucheur A, Noury-Desvaux B. Ankle-brachial index and peripheral arterial disease. N Engl J Med 2010; 362:470.
  9. Mathieu RA 4th, Powell-Wiley TM, Ayers CR, et al. Physical activity participation, health perceptions, and cardiovascular disease mortality in a multiethnic population: the Dallas Heart Study. Am Heart J 2012; 163:1037.
  10. Levien DH. Vascular surgery. In: Introduction to Surgery. 2nd ed. 1993:208-14.
  11. Buchwald H, Bourdages HR, Campos CT, et al. Impact of cholesterol reduction on peripheral arterial disease in the Program on the Surgical Control of the Hyperlipidemias (POSCH). Surgery 1996; 120:672.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-21 20:23