Peripheral vascular disease (PVD) is a general term for disease of any blood vessel that is not part of the heart or brain. The arterial form, usually referred to as PAD, is caused by deposits of fatty material (atheroma) in arteries of the legs. Since arteries carry oxygen-rich blood to the cells of the body, restriction of this blood flow can cause bodily organs to fail.
This is a potentially serious condition that requires care from your doctor. The sooner PAD is treated, the more favorable the outcome. If you suspect you have this condition, contact your doctor.
PAD is usually caused by a gradual buildup of plaque within the arteries ( atherosclerosis ). Other causes include blood clots or embolisms, congenital heart disease, and inflammation of the blood vessels (vasculitis).
PAD can be hereditary. More commonly, you may get PAD if you are overweight or obese , or have high blood pressure , diabetes , or high cholesterol . Unhealthy lifestyle choices such as smoking, eating a high-fat diet, and not exercising enough frequently lead to PAD.
The following factors increase your chance of developing PAD. If you have any of these risk factors, discuss them with your doctor:
High blood pressure (or family history)
Coronary heart disease (or family history)
Stroke (or family history)
High cholesterol (or family history)
Age over 50
High homocysteine level in blood
Family history of PAD
Symptoms of PAD are related to the organ or part of the body deprived of adequate circulation. This includes:
Claudicationpain, fatigue, aching, tightness, weakness, cramping or tingling in the leg(s) brought on by exercise that goes away when resting, in mild disease
Numbness and pain of the legs or feet at rest in more severe disease
Cold hands, legs, or feet
Loss of hair on the legs and/or feet at night
Paleness or blueness of the legs
Weak or absent pulse in the leg
Sores, ulcer, or infection of the feet and legs that heal slowly
Swelling in lower extremities
Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:
Checking the strength of the pulse in the leg arteries
Listening for a whooshing sound in a leg artery or the abdomen using a stethoscope
Ultrasound and doppler analysis of the arteries, especially the carotid arteries in the neck which supply the brain with blood
Checking blood pressure at various points in the leg and comparing it to the normal arm blood pressure
Blood tests for blood lipids, homocysteine, fasting blood sugar, hemoglobin A1C, oxidative stress marker (eg 8-iso-PGF 2 alpha)
Electrocardiogram (ECG, EKG) a test that records the heart's activity by measuring electrical currents through the heart muscle
Angiography of the arteries in the legs (x-rays of blood vessels that have been injected with a dye)
MRI a test that uses magnetic waves to make pictures of the blood vessels
Early treatment can slow or stop the advancement of the disease. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Blood pressure control
Increased physical activity (eg, walking program)
Weight loss if overweight
Low-saturated fat, low-cholesterol diet
Attentive foot care (very important for people with diabetes)
Shoes that fit properly
Proper treatment of all foot injurieshealing is slowed when circulation is poor, and the risk of infection is higher
Antiplatelet agents such as aspirin and clopidogrel to thin your blood
Medicines to reduce leg pain (eg, pentoxifylline)
Medicines to help improve walking distance (Cilostazol, Simvastatin)
Cholesterol-lowering agents (statins)
Medicines to enlarge or dilate the affected artery(ies)
Balloon angioplasty a balloon is inflated in the artery to stretch it
Stent implanta wire mesh tube is placed in the artery; the stent expands and stays in place, keeping the artery open
Surgery to open up narrowed arteries is performed in severe cases.
Endarterectomy the lining of the artery is removed
Bypass surgerya vein from another part of the body or a synthetic graft replaces the vessel
To help reduce your chances of getting PAD, make the lifestyle changes listed above under treatment.
Management of Peripheral Arterial Disease
TransAtlantic Inter-Society Consensus
Vascular Disease Foundation
Canadian Society for Vascular Surgery
Heart and Stroke Foundation of Canada
American College of Cardiology and American Heart Association 2005 Practice Guidelines for the management of patients with peripheral arterial disease. Circulation . 2006;113:e463-654.
Arteriosclerosis of the extremities. Medline Encyclopedia. US National Library of Medicine. National Institutes of Health website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000170.htm . Accessed August 9, 2005.
Diagnosis of peripheral arterial disease (PAD) is important for people with diabetes. Vascular Disease Foundation website. Available at: http://www.vdf.org/Resources/pr_pad_diagnosis.php . Accessed August 9, 2005.
Gey DC, Lesho EP, Manngold J. Management of Peripheral Arterial Disease. Am Fam Physician . 2004;69(3):525-32.
Information from your family doctor: Peripheral Arterial Disease website. American Family Physician website. Available at: http://www.aafp.org/afp/20040201/533ph.html . Accessed August 9, 2005.
Lumsden AB, Rice TW. Medical management of peripheral arterial disease:a therapeutic algorithm. J Endovasc Ther . 2006;13 (suppl2)II19-29.
Mahmud E, Cavendish JJ, Salami A: Current treatment of peripheral arterial disease: role of percutaneous interventional therapies. J Am Coll Cardiol 2007;50:473-90.
Peripheral arterial disease (PAD). Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00537 . Accessed August 9, 2005.
Peripheral vascular disease. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4692 . Accessed August 9, 2005.
Regensteiner JG, Stewart KJ. Established and evolving medical therapies for claudication in patients with peripheral arterial disease. Nat Clin Pract Cardiovasc Med . 2006;3: 604-10.
Last reviewed January 2008 by David Juan, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.