Peripheral Vascular Disease

Overview

Peripheral vascular disease (PVD) is a condition in which the blood vessels outside the heart and brain become narrowed or blocked, reducing blood flow. When the arteries are affected, the term peripheral artery disease (PAD) is often used. It most commonly affects the legs.

The usual cause is atherosclerosis, a buildup of fatty deposits (plaque) that narrows the arteries. Reduced blood flow can cause leg pain when walking and, in severe cases, sores that do not heal. PVD is also a warning sign of widespread artery disease, so it raises the risk of heart attack and stroke. With treatment, symptoms often improve and serious complications can be reduced.

Symptoms

Many people have mild or no symptoms early on. When symptoms occur, common ones include:

• Cramping, aching, or fatigue in the legs or hips that comes on with walking and eases with rest (claudication)
• Coldness, numbness, or weakness in the lower legs or feet
• Changes in skin color, shiny skin, or hair loss on the legs
• Slow-healing sores or ulcers on the feet or toes
• Weak or absent pulses in the legs or feet

Severe disease can cause pain in the feet or toes at rest, especially at night, and skin that becomes pale, blue, or develops sores. Sudden, severe leg pain with coldness and pallor is an emergency.

Causes

The most common cause is atherosclerosis, in which fatty plaque builds up on the inner walls of arteries and narrows them, limiting blood flow to the limbs. The same process that affects the heart and brain affects the peripheral arteries.

Less commonly, peripheral vascular disease results from inflammation of blood vessels, injury to a limb, abnormal anatomy of muscles or ligaments, or blood clots. Spasm of the blood vessels, as in Raynaud's, can also reduce flow temporarily.

Risk Factors

• Smoking, which is one of the strongest risk factors
• Diabetes
• High blood pressure
• High cholesterol
• Older age
• A family or personal history of vascular disease, heart disease, or stroke
• Being overweight and physical inactivity

Diagnosis

Diagnosis begins with a history and physical exam, including checking pulses in the legs and feet and looking at the skin. Tests may include:

• Ankle-brachial index (ABI): Compares blood pressure at the ankle and the arm to detect reduced flow in the legs.
• Ultrasound: Shows blood flow and locates narrowed or blocked segments.
• Angiography: Imaging with contrast dye, sometimes using CT or MRI, to map the arteries before treatment.
• Blood tests: To check for diabetes, cholesterol, and other risk factors.

Treatment

Treatment aims to relieve symptoms, improve walking, and lower the risk of heart attack and stroke.

• Lifestyle changes: Stopping smoking is the single most important step. A supervised walking program often improves how far a person can walk.
• Managing risk factors: Controlling blood pressure, cholesterol, and diabetes.
• Medications: Drugs to prevent blood clots, lower cholesterol, and sometimes improve walking distance.
• Procedures: For severe disease, angioplasty (opening the artery, sometimes with a stent) or bypass surgery can restore blood flow.
• Foot care: Careful attention to the feet to prevent and treat sores, especially in people with diabetes.

Prevention

• Do not smoke, and seek help to quit if you do
• Keep blood pressure, cholesterol, and blood sugar within target ranges
• Stay physically active, including regular walking
• Eat a balanced diet and maintain a healthy weight
• Inspect and care for your feet daily, particularly if you have diabetes

When to See a Doctor

See a doctor if you have leg pain or cramping when walking that eases with rest, numbness or coldness in a leg or foot, or a sore on your foot or leg that is slow to heal. People with risk factors such as smoking or diabetes should mention any leg symptoms.

Seek emergency care for sudden, severe leg or foot pain with coldness, paleness, numbness, or loss of movement, which can indicate a sudden blockage of blood flow and needs urgent treatment.

Related Topics

Frequently Asked Questions

References

1. National Heart, Lung, and Blood Institute (NHLBI). Peripheral Artery Disease.
2. Mayo Clinic. Peripheral artery disease (PAD) — Symptoms and causes.
3. MedlinePlus, U.S. National Library of Medicine. Peripheral artery disease.
4. Centers for Disease Control and Prevention (CDC). Peripheral Arterial Disease (PAD).