Peripheral Vascular Disease

Questions and Answers about Peripheral Vascular Disease (PVD)

Q: What is Peripheral Vascular Disease?
A: Peripheral vascular disease, of PVD, is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged, slowing or stopping the flow of blood. PVD is sometimes called peripheral arterial disease of PAD.

Q: What are the symptoms of PVD?
A: The most common symptom of PVD is called intermittent claudication, a pain in the leg, particularly when walking. Other symptoms may include numbness, tingling, and weakness in your leg. In severe cases, patients may develop an ulcer, a sore, on the leg or foot that doesn't heal. If left untreated ulcers can become infected. In extreme cases, untreated PVD can lead to gangrene, a serious condition that may require amputation of a leg or foot.

Q: What causes PVD and intermittent claudication?
A: PVD and intermittent claudication are caused by atherosclerosis, or hardening of the arteries. Atherosclerosis is a gradual process in which cholesterol and scar tissue build up inside the artery, forming a substance called "plaque" that clogs the artery. PVD symptoms also can develop when a blood clot forms in the artery.

Q: Why does PVD occur?
A: It is not know for certain why PVD occurs. Factors that contribute to the disease include smoking, high blood pressure, diabetes, high cholesterol, a family history of heart or vascular disease, or being over weight.

Q: What can be done to stop the progression of PVD?
A: In some cases PVD can be successfully controlled by certain lifestyle changes, such as exercise programs and dieting to lose weight and lower blood cholesterol. The single most important thing you can do to slow PVD is to stop smoking.

Q: How is PVD treated?
A: When lifestyle changes alone are not enough to control the symptoms of PVD, there are a number of treatment options, including:

Medication. Medications that lower cholesterol or control high blood pressure may be prescribed. Medication also is available that has been shown to significantly increase pain free walking distance and total walking distance in people with intermittent claudication. Other medications that help prevent blood clots or the build-up of plaque in the arteries are available, as well.

Angioplasty. In this procedure, an interventional radiologist inserts a very small balloon attached to a thin tube (catheter) into a blood vessel through a small nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery. In some cases, a tiny metal cylinder, or stent, is left behind in the artery to keep it open.

Thrombolytic therapy. This treatment is used by an interventional radiologist if the blockage in the artery is caused by a blood clot. Thrombolytic drugs-sometimes called clot-busting drugs- dissolves the clot and restores blood flow. Usually, the drugs are administered through a catheter directly into the clot. These drugs are frequently combined with another treatment, such as angioplasty.

Bypass grafts. In this procedure, a vein graft from another part of the body of a graft made of artificial material is used to create a detour around the blocked artery. Bypass grafts typically require surgery, but other ways of placing the graft without major surgery are developing.

Thrombectomy. This procedure is used only when symptoms of PVD develop suddenly as the result of a blood clot. In the technique, a balloon catheter is inserted into the affected artery beyond the clot. The balloon is inflated and pulled back, bringing the clot with it. Thrombectomy usually is performed as an open surgical procedure.

Q: How do I know which treatment will best be best for me?
A: The best treatment for PVD depends on a number of factors, including your overall health, the location of the affected artery, and the size and nature of the blockage or narrowing in the artery.

Q: What is an interventional radiologist?
A: Interventional radiologists are physicians who have special training to diagnose and treat conditions using tiny, miniaturized tools, while watching their progress on X-ray or other imaging equipment. Typically, the interventional radiologist performs procedures through very small incisions in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for the patient than surgery because they involve smaller incisions, less pain, and shorter hospital stays. Your interventional radiologists will work closely with your primary care or other physician to be sure you receive the best possible care.

Q: Who is at risk for PVD and intermittent claudication?
A: As many as 10 million people in the U.S. may have PVD. It is estimated that 4 million of those suffer leg pain symptoms. Those who are at higher risk are: 

• Over the age of 50
• Smokers
• Diabetic
• Overweight
• People who do not exercise
• People with high blood pressure or high cholesterol.
• A family of heart or vascular disease may also put you at higher risk for PVD.

Q: How is PVD Diagnosed?
A: The most common test for PVD is the ankle-brachial index (ABI), a painless exam in which ultrasound is used to measure the ratio of blood pressure in the feet and arms. Based on the results of your ABI, as well as your symptoms and risk factors for PVD, the physician can decide if further tests are needed. PVD also can be diagnosed noninvasively with an imaging technique called magnetic resonance angiography (MRA), or with computed tomography (CT) angiography.

Q: How can I find out if I have PVD?
A: If you suspect that you may have PVD, it is important that you see your personal physician for an evaluation.