Peripheral Vascular Disease: What You Need to Know

Closeup of a atherosclerosis -- 3D rendering; blog: Peripheral Vascular Disease: What You Need to Know

Many conversations about vascular health revolve around the blood vessels in the heart. While there are good reasons to focus on heart health, there are blood vessels all over the body that need to function properly as well. Peripheral vascular disease (PVD) affects veins and arteries outside the heart. The same things that put you at risk for cardiovascular conditions like coronary artery disease can lead to PVD. So, here’s what you need to know:

What is Peripheral Vascular Disease?

Peripheral vascular disease refers to a group of circulation diseases and disorders affecting blood vessels outside of the heart (peripheral vessels). Peripheral vessels that are affected by PVD may be in the brain, kidneys, gut, or extremities. In PVD, blood circulation is decreased due to blockages or damage to the veins and arteries.

PVD can either be functional or organic:

  • Functional PVD is caused by your body’s response to your surroundings. Blood vessels naturally widen and narrow in different conditions, but in PVD, the body’s response is more extreme. Causes of functional PVD include stress, cold temperatures, drugs, and vibrations from machinery.
  • Organic PVD is caused by structural changes in the blood vessels. Structural issues can occur when blood vessels are damaged by atherosclerosis, which is the buildup of plaque that causes inflammation.

Atherosclerosis can be caused by different things, including high cholesterol. Over time, cholesterol plaque builds up along the walls of arteries, narrowing the vessel and restricting blood flow. When the only vessels affected by PVD are arteries, the condition is referred to as peripheral artery disease or PAD. 

Veins do not develop cholesterol build-up, but can still be affected by PVD. According to the American College of Cardiology, venous insufficiency is a common disease in which the valves that help your blood circulate from your legs back up to your heart no longer function correctly. The failure of the valves causes blood to flow backward, rather than upward to the heart.

Symptoms

Sometimes peripheral vascular disease is asymptomatic, meaning there are no symptoms. However, people who do show signs of the disease may experience:

  • Intermittent claudication (painful leg cramps that happen during exercise and then go away when legs are rested)
  • Weakness, numbness, or heaviness in muscles
  • Skin changes that may include decrease in temperature and thin, brittle or shiny skin on the legs and feet
  • Gangrene, or tissue that dies due to loss of blood flow
  • Impotence
  • Weak pulse in legs and feet
  • Loss of mobility
  • Hair loss on legs
  • Wounds on pressure points (heels or ankles) that do not heal
  • Burning or aching pain in toes while lying down at night
  • Thick, opaque toenails
  • Paleness when legs are elevated
  • Red-blue discoloration in limbs

Diagnosing the Condition

Symptoms of PVD be signs of other conditions, so a definitive diagnosis needs to be made before treatment can begin. The first thing a doctor will do when diagnosing any condition is to perform a comprehensive physical exam and get a complete medical history from the patient. The medical history should include the patient’s past illnesses and injuries, previous surgeries, and current medical conditions as well as relevant family medical history.

Further testing for PVD may include:

  • Angiogram: an X-ray of veins and arteries to check for blockages
  • Magnetic Resonance Angiography (MRA): a non-invasive imaging test that uses a computer, a large magnet and radio frequencies to create detailed images of organs and vessels in the body. Dye is injected to make blood vessels stand out.
  • Exercise Test: Your doctor monitors your blood circulation while you walk on a treadmill.
  • Ankle-Brachial Index (ABI): Both regular blood pressure cuffs and Doppler ultrasound devices are used to get a comparison of the blood pressure in your ankle to the blood pressure in your arm. Your ABI is calculated by dividing the systolic blood pressure of your ankle by the systolic blood pressure of your arm.
  • Photoplethysmography (PPG): Similar to ABI, this test uses a blood pressure cuff and a special sensor to measure the blood pressure in your toe. This measurement is compared to the blood pressure in your arm.
  • Reactive Hyperemia Test: Used in place of an ABI or exercise test for people who are not able to walk on a treadmill. With the patient lying on their back, the doctor measures the blood pressure on the thighs and compares it to the blood pressure of the ankles.
  • Doppler Ultrasound Flow Studies: High-frequency sound waves are used to produce images of your blood vessels and organs. These images can be used to measure blood flow.
  • Pulse Volume Recording (PVR) Waveform Analysis: A device is used to measure blood volume changes in the legs.

Treatment Options

Once someone has been diagnosed with peripheral vascular disease, they can form a treatment plan with their doctors. Treatment options vary case by case, but the goal is always to prevent the disease from progressing and control symptoms. This is the best way to lower the risk of heart attack and stroke.

If blood flow to the extremities is slowed or blocked completely, serious complications can occur. Common complications caused by PVD include loss of a limb, restricted mobility, pain, and stroke. People who have PVD are three times more likely to have a stroke than those without the condition.

Some treatment options include:

  • Lifestyle Changes: Getting regular exercise, quitting smoking, and eating a healthy diet
  • Medications that improve blood flow, like blood thinners
  • Medications that relax blood vessel walls
  • Treatment of conditions that can complicate or worsen PVD, like diabetes, high cholesterol, and high blood pressure
  • Vascular surgery to bypass blockages
  • Angioplasty to open up arteries so blood flow can increase

Preventing PVD

There are changes you can make to your lifestyle to prevent PVD. Taking steps to improve your cardiovascular disease can lower your risk. Things you can do include:

  • Losing weight
  • Getting at least 30 minutes of exercise most days
  • Altering your diet to reduce fat, cholesterol, processed sugars, simple carbohydrates, and sweets. In place of those foods, increase the amounts of low-fat dairy, lean meats, fruits, and vegetables you eat.
  • Controlling high blood pressure
  • Controlling diabetes
  • Avoiding or limiting alcohol
  • Quitting smoking and avoiding other tobacco products. Also, keeping away from second-hand smoke is advisable.

Make and Appointment at PULSE

Dr. Farhan Majeed at PULSE: The Heart, Valve, and Vascular Institute provides patients with comprehensive cardio, vascular, and structural heart disease care. Our services include peripheral intervention and treatment of peripheral vascular disease. If you have questions or concerns about your cardiovascular health, call us at (941) 629-2111 or request an appointment online.

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