Peripheral vascular diseases (PVD) are diseases of the blood vessels outside of the heart and brain. The disease typically strikes the arteries that supply blood to the legs mainly, but can also affect blood flow to arms, kidneys and stomach. In PVD, the blood vessels are narrowed which is usually caused by “atherosclerosis.” This is a condition where plaque builds up inside a blood vessel. This also is called “hardening of the arteries.” Plaque decreases the amount of blood and oxygen supplied to the arms and the legs.
The primary causes of PVD include smoking, high blood pressure, diabetes and high cholesterol. Additional causes include injuries to the extremities, infection or coronary heart disease. The lifestyle choices that can increase your risk of developing PVD are being overweight, being sedentary and not engaging in physical exercise. I cannot stress enough the role that smoking plays in PVD-it’s the biggest risk factor.
Complications from undiagnosed and untreated PVD can be serious and even fatal. When the arteries leading to the legs become clogged, it can result in pain with walking (called claudication). This may even cause pain at rest as it progresses, and may lead to gangrene or non-healing wounds. This can result in limb loss and even death, if not treated promptly.
For many, there are no symptoms of PVD. For others, the first signs of PVD can begin slowly, usually with discomfort with walking. This is manifested typically with painful cramping, achiness, fatigue and burning. These usually happen when you are walking faster, on an incline or over longer distances. The pain will get worse with increased activity and subsides when you rest. Because the vessels are narrowed with plaque, they can only supply a limited amount of blood. With the reduced blood supply, additional symptoms of PVD including dramatic skin changes in the legs and feet, weak pulses in the legs and feet, wounds or ulcers on the legs and feet that won’t heal, and painful leg cramps that occur when you are in bed.
Another dangerous sign of PVD is gangrene which is tissue death that is caused by the lack of blood flow. It is important to tell your doctor if you experience any symptoms of PVD. Do not assume that the symptoms are simply the results of aging.
If you have any of the symptoms of PVD, it is important to contact your doctor. Early diagnosis is crucial to treatment and avoiding such life-threatening complications. To diagnose PVD, your physician will complete a medical history and physical exam. Some of the tests used to diagnose PVD include measuring the pulses in your legs and feet, Doppler ultrasound, taking the blood pressure at the ankle, and measuring the ability of the vessels to expand in the arms and legs.
PVD also is diagnosed with an angiography which is when a catheter is guided through an artery in the groin and passed to the targeted area. Once contrast dye is injected, an x-ray can then diagnose the clogged artery.
I feel that there are two main goals when it comes to treating PVD. The first is to control pain and symptoms, and allow the patient to remain active. The second is to stop the disease from progressing and lowering the risk of serious and life-threatening complications. Treatment typically includes lifestyle modifications such as regular exercise, a balanced diet; losing weight, and treating such conditions as diabetes, high blood pressure and cholesterol. And please-once again-stop smoking.
Numerous medications that increase blood flow to the legs and ease leg pain can be prescribed. Serious blockages may require surgery. These include angioplasty which is performed by inserting a catheter or long tube into the blocked artery. The blockage is opened after a balloon on the tip of the catheter is inflated. Sometimes a stent-which is a small wire tube-is inserted to keep the artery open. This is the minimally invasive way to fix this problem and most patients go home and back on their feet the same day. We can treat up to 70 percent of patients this way.
Open surgery, which bypasses the blocked artery, is another option. One common procedure is taking a vein from another part of the body and attaching it to the affected extremity. This allows blood to bypass the narrow area. This option is utilized when minimally invasive way is not possible.
If you feel that you are at risk for peripheral vascular disease and would like to make an appointment with KhubaibY. Mapara, MD or his colleague, Kristofer A. Bagdasarian, MD, FACS, please call 860.582.1220.Drs Mapara and Bagdasarian see patients in their offices at the Bristol Hospital located at 25 Newell Road, Suite D28. To learn more about vascular disease and our surgeons, please visit: www.bristolhospital.org/Services/Vascular-Surgery . Drs. Mapara and Bagdasarian are members of the medical staff of the Bristol Hospital Multi-Specialty Group, and the Saint Francis Medical Group.