Peripheral Vascular Disease

Basic Information

Peripheral vascular disease refers to a disorder in which the tissues, organs, and muscles do not receive the oxygen and other nutrients they require in order to function properly. It is usually caused by atherosclerosis, which is a disorder that is characterized by poor blood circulation resulting from clogged or hardened arteries. In most cases, the gradual accumulation of plaque in the arteries (the vessels that carry blood) causes the arteries to become narrow, which restricts the flow of blood throughout the body. With peripheral vascular disease, this reduced circulation typically has the most negative effect on the arms and legs.

The term "plaque" signifies a thick paste-like substance that is composed of deteriorating tissue, hardened fat, white blood cells, scar tissue, calcium, cholesterol, and cellular waste. Peripheral vascular disease is a progressive disorder, which means that its effect increases gradually over time. As plaque builds up in the arteries, it distorts the inner-lining of the arterial wall and makes rough areas that allow the plaque to "take hold" and accumulate even more. Eventually, the circulation in these arteries will become completely constricted. When atherosclerosis (the hardening of arteries) occurs in the peripheral vessels, it usually afflicts the iliac arteries (lower abdomen leading to the legs), the femoral and popliteal arteries (legs), the renal arteries (the kidneys), the carotid arteries (the neck leading to the brain), and the subclavian arteries (the arms).

When blood flow is slowed down or cut off, the oxygen and other vital nutrients that muscles, tissues, and organs need in order to efficiently function are reduced. This is because it is the task of blood to supply these parts of the body with oxygen and nutrients. When organs and muscles do not receive the proper supply of oxygenated blood, they become starved. The most common result of this "muscle starvation" is intermittent claudication. Intermittent claudication refers to a condition in which a person experiences intense pain or cramping in a muscle group during physical exertion, but then notices that the pain dissipates with inactivity. This occurs because the muscles do not receive the oxygenated and nutrient-rich blood during exercise, when the muscles need it most. The place where the person feels the pain is typically the location that is most affected by the poor blood circulation, typically the feet, hips, buttocks, calves, or thighs. If peripheral vascular disease is not treated properly, it will progress and eventually result in open sores and gangrene. Gangrene refers to a condition in which tissue is completely destroyed. In some cases, the affected part must be amputated.

Although peripheral vascular disease is usually caused by atherosclerosis, there are other potential causes. These include: deep vein thrombosis (clotting); Raynaud's disease (constricted artery in the fingers); Buerger's disease (severe inflammation of arteries in the legs); varicose or swollen veins; and, diabetes mellitus (when the body cannot process carbohydrates properly).

Peripheral vascular diseases are often classified into two groups: functional or organic. Functional disorders include Raynaud's disease. These disorders are characterized by the fact that they are not organic in cause, and they do not involve the deformation of the blood vessels. The negative effects of these disorders are short-lived and usually go away without any long-term problems. Functional peripheral vascular disease can be caused by emotional stress, smoking, cold temperatures, and work that involves vibrating machinery. Organic disorders, on the other hand, are brought about by biological alterations in the arterial structure. This can happen during inflammation of the blood vessels, or after tissue damage. An example of organic peripheral vascular disease is Buerger's disease.

Peripheral vascular disease afflicts tens of thousands of people. It usually affects men over the age of fifty. Men are more likely to develop this disease than women. It is not known what causes peripheral vascular disease. If a person smokes, has high blood pressure, has diabetes, has high cholesterol, is overweight, or has a family history of heart or vascular disease, they have a high risk of developing peripheral vascular disease. Diabetes is a high risk factor because a person with this condition does not have the capacity to adequately process and utilize sugar. The resulting sugar accumulation in the arteries can alter blood vessels and constrict blood flow.

Symptoms

Symptoms vary according to the location of the afflicted artery, and the cause and severity of the arterial constriction. The most common symptom is intermittent claudication. This is the cramping pain that appears during exertion and which immediately goes away with rest. Most often, symptoms of peripheral vascular disease occur in the legs. Symptoms that occur when the blood flow to the legs is cut off include:

• pain in the leg immediately after waking
• intermittent claudication, with pain increasing with exertion or exposure to cold
• cold legs and feet
• paleness of legs and feet when elevated
• blue/red discoloration of the feet or toes
• fragile or shiny-looking skin
• numbness in the leg
• tingling in the leg
• sores or ulcers on the leg that do not heal
• gangrene
• impotence

Symptoms that may occur when blood circulation is cut off from the carotid artery (the neck to the brain) include:

• sudden, temporary weakness or numbness of the face, arm, leg on one side of the body
• temporary loss of speech or difficulty speaking or trouble understanding speech
• temporary dimness or loss of vision, often in just one eye
• inexplicable dizziness or loss of balance; sudden falls

When circulation is cut off from the renal artery (the kidney), the symptoms may include:

• hypertension (chronic high blood pressure)
• abnormal or impaired kidney function
• damage to kidneys so that they cannot filter out waste and balance salt and fluid levels

Diagnosis/Treatment

Although diagnosis of peripheral vascular disease is not difficult, there are other disorders with symptoms that can resemble those of this disease. For instance, transient ischemic attacks (also known as TIA's) are mild strokes that induce the same symptoms as peripheral vascular disease when it affects the carotid artery. The major different is that the symptoms generated by a TIA are often even more short-lived than those of peripheral vascular disease.

In order to diagnose peripheral vascular disease, a doctor will ask about symptoms, examine the medical history of the affected person and their family, and perform a physical examination. During the physical examination, the doctor will take the pulse of the arteries located where the person is experiencing pain, and will check the person's blood pressure. In some situations, a doctor will also employ an ultrasound (a machine that uses sound waves) or magnetic resonance imaging (MRI) in order to provide an image from inside the arteries. These tests can detect both the presence and the severity of plaque accumulation inside the arteries. The test is simple and painless.

Plethysmography is an option in which blood circulation in the leg arteries is measured. This technique involves attaching electrodes to the legs and then having a plethysmograph detect fluctuations in electrical resistance caused by blood flow variations.

If the renal arteries leading to the kidneys are affected, then a blood test may indicate abnormal kidney function.

In some cases, the detailed image of the arterial condition or a plethysmographic reading may show that the blood vessel is severely constricted. In this case, a doctor will use an arteriogram in order to provide extremely precise information about the artery. An arteriogram (sometimes a doctor will use an aortagram which is basically the same thing) is a technique during which a colored dye is injected into the blood stream, and then an x-ray is taken of the affected artery. The colored dye provides contrast, so that the doctor can see atherosclerosis and other arterial abnormalities clearly.

The treatment of peripheral vascular disease often does not require surgery. There are a number of lifestyle changes that a person can make that will reduce the symptoms of the disorder and improve circulation through the peripheral arteries. These lifestyle changes can also prevent the disease from recurring.

The most important lifestyle change that a person can make during treatment is to quit smoking. An affected person should also lose weight if they are obese. Regular exercise is very important. Not only will it help the person lose weight, but also during physical exertion the muscles rub the arteries and this can facilitate the circulatory system. Most doctors recommend walking as the most beneficial from of exercise for a person with peripheral vascular disease. A person should exercise only as much as they can comfortably tolerate, and they should rest whenever pain arises. The goal with exercise is to increase the amount of exertion a little more each day. It is also important to keep the blood pressure at a healthy level. This can be done through exercise and diet. A person should maintain a healthy diet that is low in fat, salt, and cholesterol, and that predominantly consists of vegetables, fruits, grains, dried beans, poultry, fish, and other low-fat foods.

Another good lifestyle change that can aid in treatment is practicing good foot hygiene. A person should wash their feet daily; use moisturizing lotion; tuck cotton between the toes if the skin is cracking; wear comfortable shoes that "breath"; and, use cotton socks.

Also, if a person experiences pain in the legs, they ought to lower the legs.

In some cases, the doctor will prescribe medication in order to improve blood flow and relieve symptoms. Pentoxifylline (also known as Trental) is often used to thin the blood and increase circulation. Aspirin can also thin blood and limit blood clots. Other forms of medication that may be used are drugs that lower blood pressure and calcium-channel blockers, a type of medication that helps to relax the blood vessel walls.

If these forms of treatment do not slow down or stop the progression of the disease, then a doctor might suggest more advanced procedures, including surgery. Recent forms of treatment that can assist in advanced cases of peripheral vascular disease have precluded the need to use surgery. These procedures typically consist of the patient staying one night in the hospital, and the patient in most cases can resume a normal level of activity immediately afterward. These non-surgery techniques include angioplasty, stent placement, lasers, atherectomy, and thrombolytic therapy. The goal of these procedures is to treat plaque accumulation by either removing it, compressing it, or displacing it.

During balloon angioplasty, a small balloon connected to a thin tube (called a catheter) is inserted into an artery through a tiny incision in the skin. The catheter is then directed to the part of the blood vessel that is blocked, where the balloon is inflated to open up the arterial passageway. The plaque that was blocking the blood vessel is compressed against the arterial wall.

In some instances, another procedure called a "stent placement" accompanies the balloon angioplasty. A stent is a tiny mechanical tube that is inserted into the artery and kept there in order to keep the artery open.

Thrombolytic therapy involves the use of clot-busting drugs in order to treat arteries that are blocked by blood clots. These thrombolytic drugs can dissolve blood clots and improve circulation. In most situations, the drugs enter the bloodstream through a catheter directly to the site of the clot. These drugs are often used to accompany a primary procedure such as a balloon angioplasty.

In order to detect whether or not one of these non-surgical techniques has succeeded in opening the artery, a doctor will often inject a colored dye into the bloodstream and then take x-ray pictures of the artery.

In some instances, the plaque build-up is too hard or too great, which means that it will not respond to any form of treatment other than surgery. A common surgical procedure for someone with advanced peripheral vascular disease is a bypass graft. The focus of a bypass graft is to redirect the circulation of blood around the site of the arterial block. This procedure involves either grafting a vein from another part of the body or constructing an artificial vein. This vein is then connected to the arterial system and used to allow the blood flow to bypass the arterial obstruction. It is possible to place a graft in the body without major surgery.

Another open surgical procedure that may be used is a thrombectomy. A doctor will perform this procedure only when there is a sudden obstruction caused by a blood clot. During a thrombectomy, a balloon catheter is inserted into the blood vessel and guided to a point directly above the clot. The balloon is then inflated and used to pull the clot out.

In a worst-case scenario, a doctor might have to amputate or remove the part of the body that is severely affected by the peripheral vascular disease. This procedure is only used when gangrene is present, which is a permanent condition in which the tissue is dead.

Peripheral vascular disease is a condition that has a wide range of effects, from mild and short-term to severe and long-lasting. It is often treatable. It is also extremely preventable. In order to prevent the onset of peripheral vascular disease, it is advised that a person not smoke; exercise regularly; maintain a healthy body weight; and, maintain a diet that is low in fat, salt and cholesterol.