Peripheral Vascular Disease
Peripheral vascular disease (PVD), commonly (PAD) peripheral arterial disease or peripheral artery occlusive disease (PAOD), PVD is a micro vascular diseases resulting from gradual narrowing of the arteries this can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism, or thrombus formation. It causes either acute or chronic lack of blood supply
- Mild claudication
- Moderate claudication
- Severe claudication
- Ischemic pain at rest
- Minor tissue loss
- Major tissue loss
Complications of Peripheral Vascular Disease
If your peripheral artery disease is caused by a buildup of plaques in your blood vessels (atherosclerosis), you're also at risk of developing:
• Critical limb ischemia :- This condition begins as open sores that don't heal an injury, or an infection of your feet or legs. Critical limb ischemia (CLI) occurs when such injuries or infections progress and can cause tissue death (gangrene), sometimes requiring amputation of the affected limb.
• Stroke and heart attack :- The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn't limited to your legs. Fat deposits also build up in arteries supplying your heart and brain.
- pain, weakness, numbness, or cramping in muscles due to decreased blood flow.
- Sores, wounds, or ulcers that heal slowly or not at all.
- Noticeable change in color (blueness or paleness) or temperature (coolness) when compared to the other limb
- Diminished hair and nail growth on affected limb and digits.
- Intermittent pain (claudication), which may feel like cramps, muscle fatigue or heaviness (usually in the legs)
- Worsening pain during exercise (usually in the legs)
- Easing of pain during rest (usually in the legs)
- Coldness of the affected body part
- Pins and needles
- Muscular weakness
- Blue or purple tinge to the skin
- Wounds that won't heal (vascular ulcers)
- Blackened areas of skin or skin loss (gangrene)
Body tissues rely on a steady supply of blood to deliver oxygen and nutrients. A narrowed or blocked blood vessel deprives tissues of blood. Gangrene is the death and decay of tissue. There is no cure. The only treatment is surgical amputation of the affected body part.
Risk factors of peripheral vascular disease
Risk factors for peripheral vascular disease include:
- Diabetes - this is the most significant risk factor
- Cigarette smoking
- Advancing age
- Family history of peripheral vascular disease, stroke or coronary artery disease
- Medical history of stroke, cardiovascular disease or heart attack
- Overweight or obesity
- Sedentary lifestyle
- High blood pressure (hypertension)
- High blood cholesterol (hypercholesterolemia).
- Smoking - tobacco use in any form is the single most important modifiable cause of PVD internationally.
- Diabetes mellitus -
- Dyslipidemia (high low density lipoprotein [LDL] cholesterol, low high density lipoprotein [HDL] cholesterol)
- Hypertension - elevated blood pressure is correlated with an increase in the risk of developing PAD
- obese, or with a family history of vascular disease, heart attack, or stroke
Diagnosis of Peripheral Vascular Disease
Some of the tests your doctor may rely on to diagnose peripheral artery disease are
• Physical exam :- Your doctor may find signs of PAD during a physical examination, such as a weak or absent pulse below a narrowed area of your artery, whooshing sounds (bruits) over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb.
• Ankle-brachial index (ABI) :- This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
• Ultrasound :- Special ultrasound imaging techniques, such as Doppler ultrasound, can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
• Angiography :- By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor is able to trace the flow of the contrast material using imaging techniques such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment - finding the narrowed area of a blood vessel and then widening it with an angioplasty procedure or administering medication to improve blood flow.
• Blood tests :- A sample of your blood can be used to measure your cholesterol and triglycerides and to check for diabetes.
Treatments of Peripheral Vascular Disease
Treatment for peripheral artery disease has two major goals. The first is to manage symptoms, such as leg pain, so that you can resume physical activities. The second is to stop the progression of atherosclerosis throughout your body to reduce your risk of heart attack and stroke. You may be able to accomplish these goals with lifestyle changes. If you smoke, quitting is the single most important thing you can do to reduce your risk of complications. If lifestyle changes are not enough, you need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.
• Cholesterol-lowering medications :- You may take a cholesterol-lowering drug called a statin to reduce your risk factor of heart attack and stroke. The goal for people who have peripheral artery disease is to reduce low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL), or 2.6 millimoles per liter (mmol/L). The goal is even lower if you have additional major risk factors for heart attack and stroke, especially diabetes or continued smoking.
• High blood pressure medications :- . If you also have high blood pressure, your doctor may prescribe medications to lower it. The goal of this therapy is to reduce your systolic blood pressure (the top number of the two numbers) to 140 millimeters of mercury (mm Hg) or lower and your diastolic blood pressure (the bottom number) to 90 mm Hg or lower. If you have diabetes, your blood pressure target is under 130/80 mm Hg.
• Medication to control blood sugar :- . If you also have diabetes, it becomes even more important to control your blood sugar (glucose) levels. Talk with your doctor about what your blood sugar goals are and what steps you need to take to achieve these goals.
• Medications to prevent blood clots :- Because peripheral artery disease is related to reduced blood flow to your limbs, it's important to reduce your risk of blood clots. A blood clot can completely block an already narrowed blood vessel and cause tissue death. Your doctor may prescribe daily aspirin therapy or another medication that helps prevent blood clots, such as clopidogrel (Plavix).
• Symptom-relief medications :- The drug cilostazol (Pletal) increases blood flow to the limbs both by preventing blood clots and by widening the blood vessels. It specifically helps the symptom of claudication, leg pain, for people who have peripheral artery disease. Common side effects of this medication include headache and diarrhea. An alternative to cilostazol is pentoxifylline (Trental); however, it's generally less effective. But, side effects are rare with this medication.
Angioplasty and surgery
In some cases, angioplasty or surgery may be necessary to treat peripheral artery disease that's causing intermittent claudication:
• Angioplasty :- In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. Your doctor may also insert a mesh framework called a stent in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.
• Bypass surgery :- Your doctor may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around - or bypass - the blocked or narrowed artery.
• Thrombolytic therapy :- If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.
Supervised exercise program
In addition to medications or surgery, your doctor may prescribe a supervised exercise training program to increase the distance you can walk pain-free. Regular exercise improves symptoms of PAD by a number of methods, including helping your body use oxygen more efficiently.
Prevention of Peripheral Vascular Disease
The best way to prevent claudication is to maintain a healthy lifestyle. That means:
- Quit smoking if you're a smoker.
- If you have diabetes, keep your blood sugar in good control.
- Exercise regularly. Aim for 30 minutes at least three times a week after you've gotten your doctor's OK.
- Lower your cholesterol and blood pressure levels, if necessary.
- Eat foods that are low in saturated fat.
- Maintain a healthy weight.
When to seek Medical Advice
If you have leg pain, numbness or other symptoms, don't dismiss them as a normal part of aging. Call your doctor and make an appointment.
Even if you don't have symptoms of peripheral artery disease, you may need to be screened if you are:
- Over age 70
- Over age 50 and have a history of diabetes or smoking
- Under age 50 but have diabetes and other peripheral artery disease risk factors, such as obesity or high blood pressure