Index
It is the reduced circulation of blood to a part of the body other than the brain or the heart.
It is caused by a narrowed or blocked blood vessel. The main cause is atherosclerosis, which is the accumulation of fatty deposits that narrow a blood vessel, usually an artery. The narrow blood vessel reduces blood circulation to the associated body part.
Peripheral vascular disease mainly affects the blood vessels of the legs and kidneys and, less commonly, the arms.
Peripheral vascular disease is also known as peripheral artery disease, peripheral artery occlusive disease, or peripheral atherosclerosis.
When atherosclerosis occurs in the arteries of the heart, it is called coronary artery disease. Atherosclerosis in the arteries of the brain is called cerebrovascular disease.
A person with peripheral vascular disease is up to six times more likely to have a heart attack or stroke.
Symptoms
In some cases, a person with peripheral vascular disease does not have any symptoms until the condition is advanced and severe. Symptoms depend on which part of the body is deprived of enough blood, but can include:
- Intermittent pain (claudication), the patient may feel cramps, muscle fatigue or heaviness (usually in the legs).
- Worsening pain during exercise (usually in the legs).
- Pain relief during rest (usually in the legs).
- Coldness of the affected body part.
- Numbness.
- Tingle.
- Muscular weakness.
- Blue or purple tint to the skin.
- Wounds that do not heal (vascular ulcers).
- Blackened areas of the skin and tendency to gangrene.
The body’s tissues depend on a constant supply of blood to supply oxygen and nutrients. A narrowed or blocked blood vessel deprives tissues of blood.
Gangrene is the death and breakdown of tissue. There is no cure. The only treatment is surgical amputation of the affected body part.
Causes
In most cases, the cause is atherosclerosis, the accumulation of fatty deposits within the blood vessel that reduces blood flow to the area.
Commonly this occurs in the body where a blood vessel bends or subdivides.
Besides fatty deposits, other causes of peripheral vascular disease include:
- Diabetes – High blood sugar levels damage and weaken blood vessels, causing them to narrow.
- Obstruction: A blood clot (thrombus) can lodge inside the blood vessel.
- Infection: can cause scarring and narrowing of the blood vessels. Syphilis or salmonellosis, for example, can lead to peripheral vascular disease.
- Arteritis: inflammation of the arteries. Some autoimmune diseases can cause arteritis.
- Blood Vessel Defects – Blood vessels can be unusually narrow at birth. The cause is unknown.
- Spasms of blood vessels: Conditions such as Raynaud’s disease can cause narrowing of the blood vessels in response to certain factors, such as cold or stress.
Other causes of peripheral vascular disease can include:
- Injury to the arms or legs.
- Irregular anatomy of muscles or ligaments.
Risk factor’s
A risk factor increases your chance of developing a disease. Some can be changed, some cannot.
Risk factors for peripheral vascular disease include:
Risk factors you cannot change:
- Age (especially older than 50 years).
- History of heart disease.
- Male gender.
- Postmenopausal women.
- Family history of high cholesterol, diabetes, high blood pressure, peripheral vascular disease, stroke, or coronary heart disease.
Risk factors that can be modified or treated include:
- Coronary artery disease
- Diabetes.
- Over weight.
- Physical inactivity.
- Smoking or using tobacco products.
- Sedentary lifestyle.
- High blood pressure (hypertension).
- High levels of cholesterol in the blood (hypercholesterolemia).
Diagnosis
The diagnosis of peripheral vascular disease may include:
- Medical history.
- Physical exam.
- Family history.
- Pulse check, using a stethoscope to look for signs of reduced blood flow through a blood vessel.
- Ankle Brachial Index (ABI) test, which compares the blood pressure readings of the arms and legs to check for differences.
- Exercise test, usually performed on a treadmill while taking blood pressure to check for a drop in blood pressure within the affected body part.
- Scans such as ultrasound or magnetic resonance imaging (MRI) to locate narrow sections of blood vessels.
- Angiography, the injection of a contrast dye into the blood vessel that shows up on x-ray examination. This test is less common now that advanced imaging techniques, such as MRI, are available.
Treatment
Lifestyle changes are an important part of treatment, the doctor will make some suggestions.
Depending on the severity of the condition, treatment options can range from managing risk factors (through lifestyle changes and medications) to procedures or surgery to improve blood flow.
Treatment options may include:
Medicines
Treatment of conditions that help control peripheral vascular disease.
Your doctor may prescribe medications to help treat atherosclerosis, such as statins to lower LDL cholesterol and antihypertensive medications to lower blood pressure.
Medications to treat blood clots: Treatment may include various medications (including anticoagulants and antiplatelet medications) to prevent the development of blood clots and medications (including thrombolytics) that dissolve existing blood clots.
Other medical conditions, such as diabetes that can cause peripheral vascular disease to progress. The doctor will work with other specialists to help the patient manage these conditions.
Surgery
If the arteries or veins are significantly blocked and blood flow to areas of the body (usually the legs) is restricted, a surgical procedure may be performed to open the blockage and preserve limb function.
Today surgeons use the most sophisticated techniques and technology to provide the least invasive options possible, including:
Balloon angioplasty
This procedure, usually performed by a surgeon under sedation and local anesthesia, involves threading a long, thin, flexible tube (catheter) into the narrowed or blocked blood vessel through a small incision, usually in the leg.
Once the catheter reaches the narrowed or blocked site, the small balloon at its tip is inflated. This widens the blood vessel and improves blood flow.
Angioplasty is generally considered a temporary measure. The latest technology is currently in use, including drug-releasing balloons that help prevent recurrence.
Surgical stent insertion
After angioplasty, the surgeon may place a small coil, called a stent, in the blood vessel to keep the artery open.
A stent is a metal ‘sleeve’ that is implanted into a narrowed blood vessel during an angioplasty procedure to keep it open.
Stents may be impregnated with medications that help prevent scar tissue from narrowing the treated area of blood vessels.
Atherectomy
Atherectomy is a procedure that removes plaque from a blood vessel. This operation consists of cutting the fatty obstruction with a small instrument similar to a scalpel or with small rotating blades by shaving or vaporizing it with a laser at the end of the catheter.
Bypass or Bypass Surgery
This operation is generally only considered in severe cases that do not respond to other treatments or in cases that involve large sections of the diseased blood vessel.
A section of healthy vein is taken from another part of the body and surgically grafted to redirect blood flow around the blockage in the affected blood vessel, the surgeon creates a new path for blood to pass through the blocked or narrow segment of the artery .
The surgeon can sometimes use a synthetic tube to divert blood flow.
Lifestyle modifications
For some people with peripheral vascular disease, healthy lifestyle changes may be enough to prevent the condition from getting worse. Behavioral psychologists who specialize in heart disease support and help make changes, including:
- Take steps to properly control risk factors, such as diabetes or high blood pressure, as recommended by your doctor.
- Give up smoking.
- Get regular exercise. Ask your doctor for advice on appropriate activities.
- To eat healthier you should eat a diet low in fat and high in fiber.
- Maintain a healthy weight for your height and build.
- Caring for injuries in the affected area, for example covering wounds promptly and seeking immediate medical attention.
- Take all medications strictly as prescribed.
- Consult the doctor for regular check-ups.
- See your doctor if you have symptoms in the affected part of the body, such as redness, warmth, and swelling. These symptoms could be signs of infection. Treatment can include antibiotics.
- Sleep better.
- Stress management
- Restoring blood flow and preventing disease progression is the goal of treatment.
