Peripheral Vascular Disease (PVD)

Peripheral Vascular Disease, or PVD, is a disease of the blood vessels (outside the brain and heart) that affects tens of thousands of people. In this condition, the arteries that carry blood to the arms or legs become narrow or clogged, slowing or stopping the flow of blood. In the majority of patients, PVD is caused by generalized atherosclerosis - a gradual process in which cholesterol and scar tissue build up inside the artery. The disease most often affects the legs, but sometimes PVD occurs in the arms or in the neck affecting the arteries supplying blood to the brain. In some cases the renal artereries may also be narrowed, resulting in untreatable hypertension and kidney damage.

Many people live with the symptoms of PVD - such as numbness or pain in the legs or arms, believing it is arthritis or part of the normal aging process. The condition can often be treated successfully with exercise and medications or invasive procedures (angioplasty or surgery).

Symptoms of Peripheral Vascular Disease

The symptoms of PVD of the lower extremities usually begin gradually. People who have PVD are often unaware of subtle symptoms and do not seek medical advice until the disease is advanced. Approximately 50% of patients do not experience any symptoms, 45% have intermittent claudication (see definition below) and about 5% experience pain at rest, ulceration or gangrene.

Intermittent claudication: This is the most common symptom of PVD, and is characterized by a progressive aching or cramping sensation which is triggered by walking and relieved by rest, even simply standing in one place. This symptom typically occurs in the muscles distal (opposite) to the occlusion site (place where the artery is obstructed). The typical location of the occlusion in patients younger than 40 years is the aorta (the main "trunk" from which the arterial system proceeds) and the iliac arteries which serve the mid-section of the body. In those over 40, the obstruction is predominantly located in the arteries that serve the lower extremities. Intermittent claudication must be differentiated from so-called pseudoclaudication, which is caused by lumbar spinal canal stenosis.

Pain at rest: This is a sign of ischemia (lack of blood flow) in the leg when blockage in the artery progresses to critical level. Most commonly it occurs at night when the patient is lying in bed. Very often dangling of the affected foot over the side of the bed or getting up and walking brings relief.

Ulcers: As ischemia progresses, patients with rest pain may develop ischemic necrosis, or the death of cell due to lack of oxygen. Feet are most frequently affected. Non-healing ulcers after minor trauma are another typical presentation of severe PVD.

Muscular atrophy: This is a result of the combination of chronic limb ischemia and reduced physical activity secondary to pain. This form of musclular atrophy often causes difficulty with rehabilitation after revascularization and can compromise physical therapy.

How is PVD Diagnosed?

Clinical history and detailed physical exam taken by your physician is the first method of diagnosis

The ankle-brachial index: A simple test in which the ratio of blood pressure in a pedal artery (artery in the foot) and the blood pressure in the brachial artery (artery in the arm) is calculated.

Duplex ultrasound: A non-invasive method of visualizing the arteries of the legs and detecting blood flow in the arteries. Lack of flow or increased blood velocity indicate blockage and gives approximate estimate of its severity.

Magnetic resonance angiography: Another non-invasive method
utilizing magnetic resonance technology to detect flow of the magnetic contrast in the arteries. It may show relatively precisely lo

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