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.

• Asymptomatic

  Two carotid lesions at follow up were asymptomatic without stroke. CONCLUSION: Endovascular treatment of peripheral vascular lesions, i.e., aortoiliac, femoropopliteal tibioperoneal and carotid lesions were satisfactory in immediate outcome. [ncbi.nlm.nih.gov]

  Risk factors The risk factors for PAD are basically the same as for coronary artery disease : diabetes mellitus cigarette smoking advancing age hypercholesterolemia hypertension overweight/ obesity Rutherford classification stage 0: asymptomatic stage [radiopaedia.org]

  Most patients are asymptomatic, but many experience intermittent claudication (pain on walking). [bmj.com]

• Congestive Heart Failure

  Despite the absence of symptoms and signs of congestive heart failure at presentation, AAS-induced cardiomyopathy with a thrombus in the left ventricle was discovered to be the aetiology of his stroke and peripheral vascular disease. [ncbi.nlm.nih.gov]

  Clinical findings: Most children with PDA do not have heart related symptoms. If the ductus is large in size, symptoms of congestive heart failure may develop. [mottchildren.org]

  […] palpitations, shortness of breath, and complications such as high blood pressure in the lungs, an enlarged heart, or congestive heart failure. [healthline.com]

  An adult with untreated PDA is at high risk for bacterial endocarditis, an infection of the lining of the heart, valves, or arteries; an enlarged heart (cardiomyopathy); pulmonary hypertension (high blood pressure in the lungs); congestive heart failure [my.clevelandclinic.org]

  Congestive Heart Failure Children and adults with moderate to large patent ductus frequently develop symptoms of congestive heart failure due to pulmonary overcirculation and left heart volume overload. [ahajournals.org]

• 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]

  Atherosclerosis is a systemic disorder; 50 to 75% of patients with PAD also have clinically significant coronary artery disease (CAD) or cerebrovascular disease. [merckmanuals.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]

  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]

  Get active: Regular exercise, such as walking, can often reduce symptoms and increase the distance you can walk without symptoms. Eat nutritious, low-fat foods and avoid foods high in cholesterol. Maintain a healthy weight. [webmd.com]

• Toe Pain

  When PAD becomes severe, you may have: Impotence Pain and cramps at night Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful Pain that is worse when you elevate your legs, and improves [medlineplus.gov]

• 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). [merckmanuals.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]

• Hypotension

  The mechanisms of their vascular complications are discussed and the peripheral arterial sequelae of hypotension induced by CAPD are emphasized. These patients are compared with the other patients in the series of 121 patients. [ncbi.nlm.nih.gov]

  Potential side effects: Verapamil: hypotension, bradycardia, constipation Diltiazem: hypotension, bradycardia, risk of heart block Nifedipine: hypotension Propranolol: asystole, asthma attacks Contraindications[edit] Organic nitrates should not be taken [en.wikipedia.org]

  These factors include sepsis, hypotension, low cardiac output (see the Cardiac Output calculator), aneurysms, aortic dissection, bypass grafts, and underlying atherosclerotic narrowing of the arterial lumen. [emedicine.medscape.com]

• 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]

  Block details: Your IP: 116.203.132.182 URL: www.siditalia.it/ricerca/journal-club/piede-diabetico/1596-the-application-of-wireless-near-infrared-spectroscopy-on-detecting-peripheral-circulation-in-patients-with-diabetes-foot-ulcer-when-doing-buerger-s-exercise [siditalia.it]

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

• Skin Ulcer

  Intervention may become necessary if pain, blood clots or skin ulcers are present. Blood Clot (thrombus) Blood clots form in the veins when blood flow is compromised. [wakemed.org]

  Common symptoms of PAD include pain during walking and rest, skin ulcers, cramping, aching, clubbing of the finger or toenails, cold skin, blue tinged skin, and slow blood refill [3]. [physio-pedia.com]

  […] radiology, vascular surgery Symptoms Leg pain when walking which resolves with rest, skin ulcers, bluish skin, cold skin[2][3] Complications Infection, amputation[4] Causes Atherosclerosis, artery spasm[5][6] Risk factors Cigarette smoking, diabetes, [en.wikipedia.org]

  Manifestations of severe PAD include ischemic leg pain that occurs at rest or the development of a nonhealing skin ulcer or gangrene. This constellation of severe ischemic symptoms is known as “critical limb ischemia” and is a medical emergency. [spectrum.diabetesjournals.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]

  […] to the other leg or to the rest of your body Poor nail growth on the toes or hair growth on the legs Erectile dysfunction, especially in men with diabetes Understanding leg pain Many people dismiss leg pain as a normal sign of aging. [heart.org]

  Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain. When to see a doctor If you have leg pain, numbness or other symptoms, don't dismiss them as a normal part of aging. [mayoclinic.org]

  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 pain in the calves or thighs of one or both legs that occurs when walking, especially fast or uphill. Pain subsides with rest. [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]

  Calf 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]

  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]

  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]

  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]

  cramps or of deterioration in kidney function. [en.wikipedia.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]

• Renal Insufficiency

  We excluded patients presenting with an ST-elevation myocardial infarction (MI) ≤ 24 hours, hemodynamic instability/shock, thrombolytic therapy ≤ 7 days, or renal insufficiency (creatinine ≥ 4 mg/dL). Mean clinical follow-up was 4.4 ± 1.1 years. [ncbi.nlm.nih.gov]

  Recent trials have added chronic renal insufficiency, 7 elevated C-reactive protein levels, 8 and hyperhomocysteinemia 9 to the list of risk factors. [aafp.org]

  When persistent in premature infants, a significant PDA can result in heart failure, pulmonary hemorrhage, renal insufficiency, feeding intolerance, necrotizing enterocolitis, and even death. [merckmanuals.com]

  Renal insufficiency and the risk of lower extremity peripheral arterial disease: results from the Heart and Estrogen/Progestin Replacement Study (HERS). J Am Soc Nephrol. 2004;15:1046–1051. 37. O'Hare AM, Bacchetti P, Segal M, et al. [journals.lww.com]

• 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]

• Agitation

  Contrast echocardiography may be helpful in this setting; intravenous injection of agitated saline leads to microbubbles in the descending aorta (from ductal right-to-left shunting) but not in the ascending aorta. [ahajournals.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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