Peripheral Vascular Disease
(PVD; PAD; Arteriosclerosis Obliterans; Atherosclerosis; Peripheral Vascular Arterial Disease)More InDepth Information on This ConditionEn Español (Spanish Version)
Peripheral vascular disease (PVD) is a general term for disease of any blood vessel that is not part of the heart or brain. The arterial form, usually referred to as PAD, is caused by deposits of fatty material (atheroma) in arteries of the legs. Since arteries carry oxygen-rich blood to the cells of the body, restriction of this blood flow can cause bodily organs to fail.
This is a potentially serious condition that requires care from your doctor. The sooner PAD is treated, the more favorable the outcome. If you suspect you have this condition, contact your doctor.
PAD is usually caused by a gradual buildup of plaque within the arteries ( atherosclerosis ). Other causes include blood clots or embolisms, congenital heart disease, and inflammation of the blood vessels (vasculitis).
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PAD can be hereditary. More commonly, you may get PAD if you are overweight or obese , or have high blood pressure , diabetes , or high cholesterol . Unhealthy lifestyle choices such as smoking, eating a high-fat diet, and not exercising enough frequently lead to PAD.
The following factors increase your chance of developing PAD. If you have any of these risk factors, discuss them with your doctor:
Symptoms of PAD are related to the organ or part of the body deprived of adequate circulation. This includes:
- Claudication—pain, fatigue, aching, tightness, weakness, cramping or tingling in the leg(s) brought on by exercise that goes away when resting, in mild disease
- Numbness and pain of the legs or feet at rest in more severe disease
- Cold hands, legs, or feet
- Loss of hair on the legs and/or feet at night
- Paleness or blueness of the legs
- Weak or absent pulse in the leg
- Sores, ulcer, or infection of the feet and legs that heal slowly
- Erectile dysfunction
- Swelling in lower extremities
- Muscle atrophy
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:
- Checking the strength of the pulse in the leg arteries
- Listening for a whooshing sound in a leg artery or the abdomen using a stethoscope
- Ultrasound and doppler analysis of the arteries, especially the carotid arteries in the neck which supply the brain with blood
- Checking blood pressure at various points in the leg and comparing it to the normal arm blood pressure
- Blood tests for blood lipids, homocysteine, fasting blood sugar, hemoglobin A1C, oxidative stress marker (eg 8-iso-PGF 2 alpha)
- Treadmill test
- Electrocardiogram (ECG, EKG) —a test that records the heart's activity by measuring electrical currents through the heart muscle
- Angiography of the arteries in the legs (x-rays of blood vessels that have been injected with a dye)
- MRI —a test that uses magnetic waves to make pictures of the blood vessels
Early treatment can slow or stop the advancement of the disease. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
- Smoking cessation
- Diabetes control
- Blood pressure control
- Increased physical activity (eg, walking program)
- Weight loss if overweight
- Low-saturated fat, low-cholesterol diet
Attentive foot care (very important for people with diabetes)
- Shoes that fit properly
- Proper treatment of all foot injuries—healing is slowed when circulation is poor, and the risk of infection is higher
- Antiplatelet agents such as aspirin and clopidogrel to thin your blood
- Medicines to reduce leg pain (eg, pentoxifylline)
- Medicines to help improve walking distance (Cilostazol, Simvastatin)
- Cholesterol-lowering agents (statins)
- Medicines to enlarge or dilate the affected artery(ies)
Surgery to open up narrowed arteries is performed in severe cases.
- Endarterectomy —the lining of the artery is removed
- Bypass surgery—a vein from another part of the body or a synthetic graft replaces the vessel
Management of Peripheral Arterial Disease
TransAtlantic Inter-Society Consensus
Vascular Disease Foundation
Canadian Society for Vascular Surgery
Heart and Stroke Foundation of Canada
American College of Cardiology and American Heart Association 2005 Practice Guidelines for the management of patients with peripheral arterial disease. Circulation . 2006;113:e463-654.
Arteriosclerosis of the extremities. Medline Encyclopedia. US National Library of Medicine. National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000170.htm . Accessed August 9, 2005.
Diagnosis of peripheral arterial disease (PAD) is important for people with diabetes. Vascular Disease Foundation website. Available at: http://www.vdf.org/Resources/pr_pad_diagnosis.php . Accessed August 9, 2005.
Gey DC, Lesho EP, Manngold J. Management of Peripheral Arterial Disease. Am Fam Physician . 2004;69(3):525-32.
Information from your family doctor: Peripheral Arterial Disease website. American Family Physician website. Available at: http://www.aafp.org/afp/20040201/533ph.html . Accessed August 9, 2005.
Lumsden AB, Rice TW. Medical management of peripheral arterial disease:a therapeutic algorithm. J Endovasc Ther . 2006;13 (suppl2)II19-29.
Mahmud E, Cavendish JJ, Salami A: Current treatment of peripheral arterial disease: role of percutaneous interventional therapies. J Am Coll Cardiol 2007;50:473-90.
Peripheral arterial disease (PAD). Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00537 . Accessed August 9, 2005.
Peripheral vascular disease. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4692 . Accessed August 9, 2005.
Regensteiner JG, Stewart KJ. Established and evolving medical therapies for claudication in patients with peripheral arterial disease. Nat Clin Pract Cardiovasc Med . 2006;3: 604-10.
Last reviewed January 2008 by David Juan, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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