Peripheral Arterial Disease

What is peripheral vascular disease (PVD) or peripheral arterial disease (PAD)? 

Peripheral vascular disease (PVD) and peripheral arterial disease (PAD) are the same condition.  It is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart. Organs supplied by these vessels such as the brain, heart, and legs, may not receive adequate blood flow for ordinary function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease. 

When PVD occurs in the arteries outside the heart, it may be referred to as peripheral arterial disease (PAD). However, the terms "peripheral vascular disease" and "peripheral arterial disease" are often used interchangeably. It's frequently found in people with coronary artery disease, because atherosclerosis, which causes coronary artery disease, is a widespread disease of the arteries. 

Conditions associated with PAD may be occlusive (occurs because the artery becomes blocked in some manner) or functional (the artery either constricts due to a spasm or expands). Examples of occlusive PAD include peripheral arterial occlusion and Buerger's disease (thromboangiitis obliterans).  

What causes peripheral vascular disease? 

PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis (the buildup of plaque inside the artery wall). Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries. 

What conditions are associated with peripheral vascular disease? 

The term "peripheral vascular disease" encompasses several different conditions. Some of these conditions include, but are not limited to:

  • Atherosclerosis. Atherosclerosis is the build up of plaque inside the artery wall. Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. The artery wall then becomes thickened and loses its elasticity. Symptoms may develop gradually, and may be few, as the plaque builds up in the artery. However, when a major artery is blocked, a heart attack, stroke, aneurysm, or blood clot may occur, depending on where the blockage occurs. 
  • Buerger's disease (thromboangiitis obliterans). This is a chronic inflammatory disease in the peripheral arteries of the extremities leading to the development of clots in the small- and medium-sized arteries of the arms or legs and eventual blockage of the arteries. Buerger's disease most commonly occurs in men between ages 20 and 40 who smoke cigarettes. Symptoms include pain in the legs or feet, clammy cool skin, and a diminished sense of heat and cold.  


What are the risk factors for peripheral vascular disease? 

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history, or many other things. Risk factors for peripheral vascular disease include factors which can be changed or treated and factors that cannot be changed.

Risk factors that cannot be changed include:

  • Age (especially older than age 50)
  • History of heart disease
  • Male gender
  • Diabetes mellitus
  • Postmenopausal women
  • Family history of dyslipidemia (elevated lipids in the blood, such as cholesterol), hypertension, or peripheral vascular disease

Risk factors that may be changed or treated include:

  • Coronary artery disease
  • Impaired glucose tolerance
  • Dyslipidemia
  • Hypertension (high blood pressure)
  • Obesity
  • Physical inactivity
  • Smoking or use of tobacco products

Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow.  

What are the symptoms of peripheral vascular disease? 

symptom free. For those experiencing symptoms, the most common first symptom is intermittent Claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest Approximately half the people diagnosed with peripheral vascular disease are). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the clogged or narrowed artery.

Other symptoms of peripheral vascular disease may include:

  • Changes in the skin, including decreased skin temperature, or thin, brittle shiny skin on the legs and feet
  • Diminished pulses in the legs and the feet
  • Gangrene (dead tissue due to lack of blood flow)
  • Hair loss on the legs
  • Impotence
  • Nonhealing wounds over pressure points, such as heels or ankles
  • Numbness, weakness, or heaviness in muscles
  • Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
  • Pallor (paleness) when the legs are elevated
  • Reddish-blue discoloration of the extremities
  • Restricted mobility
  • Severe pain
  • Thickened, opaque toenails

The symptoms of peripheral vascular disease may resemble other conditions. Consult your physician for a diagnosis.  

How is peripheral vascular disease diagnosed?  

In addition to a complete medical history and physical examination, diagnostic procedures for peripheral vascular disease may include any, or a combination, of the following: 

  • Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing of the vessels. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
  • Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm. 
  • Doppler ultrasound flow studies. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Doppler technique is used to measure and assess the flow of blood. Faintness or absence of sound may indicate an obstruction in the blood flow.
  • Magnetic resonance angiography (MRA). This noninvasive diagnostic procedure uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within the body. An MRA is often used to examine the heart and other soft tissues and to assess blood flow.
  • Treadmill exercise test. This test is given while a patient walks on a treadmill to monitor the heart during exercise.
  • Pulse volume recording (PVR) waveform analysis. This technique is used to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.
  • Segmental blood pressure measurements. This is a means of comparing blood pressure measurements using a Doppler device in the upper thigh, above and below the knee, at the ankle, and on the arm to determine any constriction in blood flow. 
What is the treatment for peripheral vascular disease? 

There are two main goals for treatment of peripheral artery/vascular disease: control the symptoms and halt the progression of the disease to lower the risk for heart attack, stroke, and other complications. 

Specific treatment will be determined by your physician based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Your signs and symptoms
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include:

  • Lifestyle modifications to control risk factors, including regular exercise, proper nutrition, and smoking cessation
  • Aggressive treatment of existing conditions that may aggravate PVD, such as diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol)
  • Medications for improving blood flow, such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls
  • Endovascular procedures—a catheter (long hollow tube) is used to create a larger opening in an artery to increase blood flow. Angioplasty may be performed in many of the arteries in the body. There are several types of endovascular procedures, including:
    • Balloon angioplasty (a small balloon is inflated inside the blocked artery to open the blocked area)
    • Atherectomy (the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter)
    • Laser angioplasty (a laser is used to "vaporize" the blockage in the artery)
    • Stent (a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open)
  • Open Vascular surgery—a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow


With both angioplasty and vascular surgery, an angiogram is often performed prior to the procedure.  

What are the complications of peripheral vascular disease?  

Complications of peripheral vascular disease most often occur because of decreased or absent blood flow. Such complications may include:

  • Amputation (loss of a limb)
  • Heart attack
  • Poor wound healing
  • Restricted mobility due to pain or discomfort with exertion
  • Severe pain in the affected extremity
  • Stroke (three times more likely in people with PVD)

By following an aggressive treatment plan for peripheral vascular disease, complications such as these may be prevented.

Can peripheral vascular disease be prevented?

Steps to prevent PVD are primarily aimed at management of the risk factors for PVD. A prevention program for PVD may include:

  • Smoking cessation, including avoidance of second hand smoke and use of tobacco products
  • Dietary modifications including reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables
  • Treatment of dyslipidemia (high blood cholesterol levels) with medications as determined by your physician
  • Weight reduction
  • Moderation in alcohol intake
  • Medications as determined by your physician to reduce your risk for blood clot formation
  • Exercise plan of a minimum of 30 minutes daily
  • Control of diabetes mellitus
  • Control of hypertension (high blood pressure)

A prevention plan for PVD may also be used to prevent or lessen the progress of PVD once it has been diagnosed. Consult your physician for diagnosis and treatment.


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