What is peripheral vascular disease?
Peripheral vascular disease (PVD) is a condition in which one or more arteries (blood vessels) become narrowed by a build-up of cholesterol-containing fatty tissue. This fatty build-up may be referred to as atherosclerosis or ‘hardening of the arteries'. PVD mainly affects the arteries supplying blood to the legs and feet. PVD is sometimes referred to as peripheral arterial disease.
PVD is more common in men than in women and becomes more common with increasing age.
What causes PVD?
PVD is caused by a gradual hardening of the arteries. This process may be caused by a combination of preventable risk factors such as high blood pressure, high cholesterol levels and smoking. Other risk factors include diabetes mellitus, obesity and an unhealthy diet. People with a personal or family history of heart disease or stroke are also at increased risk of PVD.
What are the symptoms of PVD?
The most common symptom of PVD is leg pain, which may be brought on by exercise such as walking and is relieved by rest. This pain is referred to as intermittent claudication and arises because the arteries are unable to supply sufficient oxygen to the affected area to meet the additional demands made by exercise. However, in mild cases of PVD there may be no symptoms.
In severe cases, there may be constant pain even when resting as a result of complete or partial obstruction of the arteries supplying blood to a particular area. The pain may be either cramp-like, an ache, numbness or tingling. Exposure to cold can also cause pain in the affected area.
There may be a difference in colour between the legs and feet and the rest of the body. Legs and feet may become very pale or white when raised and take time to return to a normal colour when the legs are lowered because the superficial veins are very slow to fill with blood. Feet or toes may become red or dusky blue (cyanosed) due to a lack of oxygen.
The affected limb may be much colder to the touch and feel clammy as blood flow usually brings heat to an area.
Other symptoms include hair loss from the legs and feet and dry and shiny skin. Toe nails may thicken and become brittle and ridged. If there is a very poor blood supply, ulcers may develop on the legs or toes that may be difficult to heal. In rare cases gangrene (death of tissue) of the foot may occur.
Are there any tests needed?
Basic tests will include examination of the affected area for differences in temperature, colour and sensation. The blood pressure may be measured and compared in both limbs. Pulses will also be checked as these may be weaker or absent in severe cases.
A magnetic resonance imaging (MRI) scan may be ordered to look at the blood supply. Another test that may be used is a Doppler ultrasound scan. Your doctor will explain more about these tests if necessary.
What treatment is available?
Lifestyle changes are among the most important factors in treating PVD. They can prevent further deterioration of the arteries and help to prevent worsening of the condition. See the ‘Self-help measures' section below for further information.
High blood pressure (hypertension) should be treated with medication to maintain an acceptable level of blood pressure.
Your doctor may prescribe low-dose aspirin to thin the blood and to prevent blood clots forming. Another antiplatelet drug may be added or substituted if the condition progresses.
Your doctor may also prescribe a medicine known as a vasodilator (eg, cilostazol) to enlarge or dilate the affected arteries. Other drugs that may be prescribed in PVD include inositol nicotinate, naftidrofuryl and pentoxifylline.
If symptoms are very severe, surgery may be necessary. Bypass surgery may be carried out to re-route the blood around the obstructed area. Angioplasty is a technique where a balloon catheter is passed into the artery and the balloon inflated. This compresses the fatty tissue against the artery wall thereby expanding the artery. In some cases a stent (a small mesh or synthetic tube) may be inserted into an artery to keep it open.
Amputation of the part of the limb affected is a final resort to remove gangrenous tissue.
Self-help measures:
- If you smoke, try to stop as soon as possible
- Reduce cholesterol levels by eating a low-fat, high-fibre diet
- Reduce salt in the diet by avoiding processed foods and not adding salt to cooking
- Balance exercise with rest - over time exercise can result in the development of new small blood vessels, letting the blood bypass narrowed arteries
- Keep body weight to an acceptable level for your height
- Ensure high blood pressure is treated and always take any medication prescribed to keep blood pressure at a healthy level
- Avoid tight socks, garters or elastic stockings which may hinder blood flow
- Wear shoes and socks made of natural fibres and avoid plastic or other synthetic materials
- Wear comfortable, well fitting shoes and practice good hygiene by washing and moisturising the feet daily. If necessary, visit a chiropodist regularly to ensure any ulcers or sores are noticed and treated promptly
- Keep the legs below heart level - at night elevate the head of the bed to improve blood flow to the legs
Fact sheet provided by MIMS
Date last reviewed: January 2009
