What are the main types of peripheral vascular disease. How does peripheral vascular disease affect arteries and veins. What are the risk factors for developing peripheral vascular disease. How is peripheral vascular disease diagnosed and treated. What are the complications of untreated peripheral vascular disease.

Understanding Peripheral Vascular Disease: An Overview

Peripheral vascular disease (PVD) is a complex condition affecting blood vessels outside the heart and brain. It encompasses a range of disorders impacting both arteries and veins, potentially leading to serious health complications if left untreated. This comprehensive guide delves into the various forms of PVD, their causes, symptoms, and available treatment options.

What is Peripheral Vascular Disease?

Peripheral vascular disease refers to conditions that affect blood vessels distant from the heart, including arteries and veins in the arms, legs, and organs below the stomach. When PVD specifically affects arteries, it’s termed peripheral arterial disease (PAD). The disease can manifest in various forms, such as blood clots, inflammation, or narrowing and blockage of blood vessels.

Types of Peripheral Vascular Disease

PVD encompasses several distinct conditions, each with its unique characteristics and implications for patient health. Understanding these different types is crucial for proper diagnosis and treatment.

Peripheral Arterial Disease (PAD)

PAD is a common form of PVD characterized by the narrowing of peripheral arteries, typically in the legs. It’s often caused by atherosclerosis, a condition where plaque builds up inside the arteries, restricting blood flow.

• Symptoms: Pain and cramping in the legs, especially during physical activity
• Risk factors: Smoking, diabetes, high blood pressure, high cholesterol

Aortic Aneurysms

An aortic aneurysm is a bulge in the wall of the aorta, the main artery carrying blood from the heart to the rest of the body. If left untreated, it can lead to life-threatening ruptures.

• Types: Thoracic (chest) and abdominal aneurysms
• Risk factors: Age, smoking, high blood pressure, family history

Buerger’s Disease

Buerger’s disease is a rare disorder primarily affecting young male smokers. It causes inflammation and constriction of small and medium-sized blood vessels in the arms and legs.

• Symptoms: Pain in extremities, especially during activity
• Key factor: Strong association with tobacco use

Raynaud’s Phenomenon

Raynaud’s phenomenon is a condition where small arteries in the fingers and toes spasm in response to cold or stress, temporarily limiting blood flow.

• Symptoms: Color changes in affected areas (white, blue, then red)
• Triggers: Cold temperatures, emotional stress

Deep Vein Thrombosis (DVT)

DVT occurs when a blood clot forms in a deep vein, usually in the leg. It can be dangerous if the clot breaks loose and travels to the lungs, causing a pulmonary embolism.

• Risk factors: Prolonged immobility, certain medical conditions, genetic predisposition
• Complications: Pulmonary embolism, chronic venous insufficiency

Causes and Risk Factors of Peripheral Vascular Disease

Understanding the underlying causes and risk factors of PVD is essential for both prevention and management of the condition. While some risk factors are beyond our control, many can be modified through lifestyle changes and medical intervention.

Atherosclerosis: The Primary Culprit

Atherosclerosis is the most common cause of PVD, particularly PAD. This process involves the buildup of plaque in the arteries, gradually narrowing the vessel lumen and restricting blood flow. But what leads to atherosclerosis?

• High levels of LDL cholesterol
• Chronic inflammation
• Endothelial dysfunction
• Oxidative stress

Modifiable Risk Factors

Several lifestyle factors and medical conditions increase the risk of developing PVD. By addressing these, individuals can significantly reduce their risk:

1. Smoking: Perhaps the most significant modifiable risk factor
2. Diabetes: Poorly controlled blood sugar damages blood vessels
3. Hypertension: High blood pressure strains arterial walls
4. Obesity: Excess weight contributes to inflammation and metabolic imbalances
5. Sedentary lifestyle: Lack of exercise impacts cardiovascular health
6. High cholesterol: Contributes to plaque formation in arteries

Non-modifiable Risk Factors

While we can’t change these factors, awareness can lead to earlier screening and intervention:

• Age: Risk increases with advancing years
• Gender: Men are at higher risk for certain types of PVD
• Family history: Genetic predisposition plays a role
• Race: Some ethnic groups have higher risk for specific PVD types

Symptoms and Diagnosis of Peripheral Vascular Disease

Recognizing the symptoms of PVD is crucial for early diagnosis and treatment. However, symptoms can vary widely depending on the specific type of PVD and its severity.

Common Symptoms of PAD

PAD often manifests with symptoms in the legs, particularly during physical activity:

• Intermittent claudication (pain or cramping in legs during walking)
• Numbness or weakness in the legs
• Coldness in lower leg or foot, especially compared to the other side
• Sores on toes, feet, or legs that heal slowly or not at all
• Change in color of the legs
• Hair loss or slower hair growth on feet and legs
• Slower growth of toenails
• Shiny skin on legs
• Weak or absent pulses in legs or feet

Diagnostic Procedures for PVD

Diagnosing PVD typically involves a combination of physical examination, medical history review, and various diagnostic tests:

1. Ankle-brachial index (ABI): Compares blood pressure in ankles to arms
2. Doppler ultrasound: Visualizes blood flow through vessels
3. Angiography: Provides detailed images of blood vessels using contrast dye
4. CT angiography: Combines CT scanning with angiography for 3D vessel imaging
5. Magnetic resonance angiography (MRA): Uses magnetic fields and radio waves to image blood vessels
6. Blood tests: Check for risk factors like diabetes and high cholesterol

Treatment Options for Peripheral Vascular Disease

Treatment for PVD aims to manage symptoms, slow disease progression, and reduce the risk of complications. The approach varies based on the specific type of PVD, its severity, and individual patient factors.

Lifestyle Modifications

For many patients, lifestyle changes are the first line of defense against PVD:

• Smoking cessation: Critical for improving vascular health
• Regular exercise: Improves circulation and overall cardiovascular health
• Healthy diet: Emphasizing fruits, vegetables, whole grains, and lean proteins
• Weight management: Reduces strain on the circulatory system
• Stress reduction: May help manage conditions like Raynaud’s phenomenon

Medications

Various medications may be prescribed to manage PVD and its risk factors:

1. Antiplatelet agents (e.g., aspirin, clopidogrel): Reduce blood clot formation
2. Statins: Lower cholesterol and may help stabilize arterial plaques
3. Antihypertensives: Control blood pressure
4. Cilostazol or pentoxifylline: Improve walking distance in PAD patients
5. Anticoagulants: Prevent blood clot formation in conditions like DVT

Interventional Procedures

In more severe cases, minimally invasive or surgical interventions may be necessary:

• Angioplasty and stenting: Opens narrowed arteries
• Atherectomy: Removes plaque from blood vessels
• Bypass surgery: Creates a new path for blood flow around blocked arteries
• Thrombolysis: Dissolves blood clots using medication
• Aneurysm repair: Treats aortic aneurysms to prevent rupture

Living with Peripheral Vascular Disease: Management and Prevention

Managing PVD is an ongoing process that requires active participation from patients. With proper care and lifestyle adjustments, many individuals with PVD can maintain a good quality of life and reduce their risk of complications.

Long-term Management Strategies

Effective long-term management of PVD involves:

• Regular medical check-ups to monitor disease progression
• Adherence to prescribed medications
• Ongoing lifestyle modifications, including diet and exercise
• Proper foot care, especially for those with diabetes or PAD
• Participation in supervised exercise programs, when recommended
• Management of co-existing conditions like diabetes and hypertension

Preventing Complications

Vigilance is key in preventing serious complications of PVD:

1. Monitor for signs of infection or poor wound healing, especially in the extremities
2. Be aware of symptoms that could indicate worsening of the condition
3. Follow guidelines for preventing DVT during long periods of immobility
4. Manage stress and avoid triggers for conditions like Raynaud’s phenomenon
5. Maintain good skin care to prevent ulcers and infections

Psychological Aspects of Living with PVD

Coping with a chronic condition like PVD can be challenging. Patients may benefit from:

• Support groups for individuals with vascular diseases
• Counseling or therapy to address anxiety or depression related to the condition
• Stress management techniques such as meditation or yoga
• Education programs to better understand and manage their condition

Emerging Research and Future Directions in PVD Treatment

The field of vascular medicine is constantly evolving, with new research offering hope for improved diagnosis, treatment, and prevention of PVD. Several exciting areas of study are currently underway.

Advances in Diagnostic Techniques

Researchers are developing more sensitive and less invasive diagnostic tools:

• Advanced imaging techniques for earlier detection of vascular changes
• Biomarkers for identifying patients at high risk of PVD progression
• Wearable devices for continuous monitoring of vascular health

Novel Therapeutic Approaches

Innovative treatments on the horizon include:

1. Gene therapy to promote new blood vessel growth (angiogenesis)
2. Stem cell treatments to repair damaged blood vessels
3. Nanotechnology for targeted drug delivery to affected areas
4. New anticoagulants with improved safety profiles
5. Personalized medicine approaches based on genetic profiles

Prevention Strategies

Research is also focusing on better ways to prevent PVD:

• Development of more effective smoking cessation methods
• Studies on dietary interventions to reduce vascular inflammation
• Investigation of novel exercise protocols for vascular health
• Research into the gut microbiome’s role in vascular disease

As research progresses, we can expect to see more targeted and effective approaches to managing PVD, potentially leading to better outcomes and improved quality of life for patients affected by these conditions.

Global Impact and Public Health Considerations of PVD

Peripheral vascular disease is not just a medical concern; it’s a significant public health issue with far-reaching implications. Understanding the global impact of PVD is crucial for developing effective strategies to combat this growing health challenge.

Epidemiology and Prevalence

PVD affects millions of people worldwide, with prevalence varying by region and demographic factors:

• Global estimates suggest that over 200 million people are affected by PAD alone
• Prevalence increases sharply with age, affecting up to 20% of people over 70
• Low- and middle-income countries are seeing rising rates of PVD due to increasing risk factors
• Certain ethnic groups show higher susceptibility to specific types of PVD

Economic Burden

The economic impact of PVD is substantial, affecting healthcare systems and economies:

1. Direct medical costs for treatment and management
2. Indirect costs due to lost productivity and disability
3. Long-term care expenses for complications like amputations
4. Research and development costs for new therapies

Public Health Strategies

Addressing PVD on a population level requires comprehensive public health approaches:

• Awareness campaigns to educate the public about PVD risk factors and symptoms
• Screening programs for early detection in high-risk populations
• Policy interventions to reduce risk factors (e.g., tobacco control measures)
• Integration of PVD prevention into primary care and chronic disease management programs
• Improving access to specialized vascular care, especially in underserved areas

By addressing PVD as a global health priority, we can work towards reducing its prevalence, improving outcomes for affected individuals, and lessening its societal and economic impact.

Peripheral Vascular Disease | The Texas Heart Institute

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Peripheral vascular disease (PVD) involves damage to or blockage in the blood vessels distant from your heart—the peripheral arteries and veins.

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Your peripheral arteries and veins carry blood to and from your arm and leg muscles and the organs in and below your stomach area. PVD may also affect the arteries leading to your head (see Carotid Artery Disease). When PVD affects only the arteries and not the veins, it is called peripheral arterial disease (PAD). The main forms that PVD may take include blood clots (for example, deep vein thrombosis or DVT), swelling (inflammation), or narrowing and blockage of the blood vessels.

Diseases of the arteries may lead to

Disease of the veins may lead to

Much like the coronary arteries, the peripheral arteries can be blocked by plaque. PVD can result from a condition known as atherosclerosis, where a waxy substance forms inside of the arteries. This substance is called plaque. When enough plaque builds up on the inside of an artery, the artery becomes clogged, and blood flow is slowed or stopped. This slowed blood flow may cause “ischemia,” which means that your body’s cells are not getting enough oxygen. Clogged peripheral arteries in the lower part of the body (also referred to as peripheral artery disease or PAD) most often cause pain and cramping in the legs. The risk factors for atherosclerosis in the peripheral arteries are the same as those for atherosclerosis in the coronary arteries. Smoking, diabetes, high blood pressure, and high cholesterol are believed to lead to the development of plaque.

An aneurysm is a balloon-like bulge in the wall of a weakened blood vessel. If the bulging stretches the vessel wall too far, the vessel may burst. The aorta is the artery that carries blood from the heart to the rest of the body. An aneurysm in the aorta is called an aortic aneurysm. You can die if an aneurysm causes this main artery to burst and it is not treated in time. An aortic aneurysm may be located in your chest (thoracic aneurysm), but most are located below the kidneys in the lower stomach area (abdominal aneurysms).

Buerger’s disease is related to smoking. The disease causes swelling of the small and medium-sized arteries (and sometimes the veins) in your feet and legs. This rare disorder, which causes the peripheral vessels to tighten or constrict, is more common in men, especially smokers aged 20 to 40. Smoking causes the blood vessels to tighten in everyone who smokes. But in people with Buerger’s disease, there is so much tightening in the vessels that a lack of oxygen to the cells (ischemia) or tissue death (necrosis) may result. The symptoms may be different for everyone, but the condition most often causes tender, swollen areas over the vessels, followed by coldness of the feet and hands. Pain in the legs during walking (called intermittent claudication) may happen because of an arterial blockage. The most serious cases sometimes cause the tissue to die, and amputation of the fingers and toes may be needed. People with Buerger’s disease must stop smoking completely, and circulation usually improves soon after.

Raynaud’s phenomenon happens more often in women. It is a circulation disorder that causes the arteries in the fingers and toes to tighten or spasm when they are exposed to cold temperatures, smoking, or emotional stress. Often, the cause of Raynaud’s phenomenon is not known. Sometimes, it is a side effect of other conditions, such as connective tissue disease, trauma, or diseases of the glands or central nervous system. People with the disorder may feel numbness or tingling in their fingers and toes. They may also notice that their skin turns pale or blue, followed by reddening in the affected areas. Attacks may last from a few minutes to several hours and are usually treated with gradual warming of the fingers and toes to restore blood flow. Therapy may also include pain relievers, calcium channel blockers, quitting smoking, and avoiding cold temperatures and emotional upset.

Nearly 6 million Americans have a blood clot in their veins (also called venous thrombus, venous thrombosis, or vein thrombosis). When the clot develops in a vein deep within the leg, it is called deep vein thrombosis (DVT). The condition can be life threatening if the clot breaks loose from the vein and travels to the lungs, where it can completely block blood flow.

Pulmonary embolism is caused by a blood clot (pulmonary embolus) that breaks loose from where it formed in a vein and travels to your lungs. Pulmonary embolism may have no symptoms, so it can cause sudden, unexpected death. When symptoms do happen, they may include

• Chest pain, especially when you breathe in
• Shortness of breath
• Coughing up blood
• Dizziness
• Fainting

There are two forms of phlebitis. The most common form is swelling of a vein near the skin’s surface, usually in the leg. This is called superficial phlebitis. Swelling of the veins inside the leg is less common but more serious. This is called deep phlebitis. For superficial phlebitis, the area looks reddish and feels painful. The pain of this condition can usually be treated with moist heat, aspirin, or anti-inflammatory medicines. The more dangerous form of phlebitis, deep phlebitis, usually causes greater pain. People with deep phlebitis tend to have a fever. Nuclear scans, venous Doppler flow studies, or the use of a blood pressure cuff around the leg to measure blood flow (plethysmography) will usually confirm if the deep veins are involved. This type of phlebitis is more likely to lead to blood clots in the veins and a possible blood clot in the lungs (pulmonary embolus). If you are diagnosed with deep phlebitis, doctors will usually give you a week-long treatment with a blood-thinning, or anticoagulant, medicine. During this time, doctors will also check for signs of blood clots in your lungs. Your doctor will probably give you an anticoagulant in pill-form to be taken longer-term.

Varicose veins are swollen, purple veins in the legs that are visible under your skin. They are caused by damage to blood vessels close to the surface of your skin, slowed blood flow, or the damage or absence of normal valves in your veins. Normally, blood flow in the veins is aided by valves, which keep the blood moving upward, against the force of gravity. If these valves are weak or blood flows slowly in the veins, the blood may pool and cause the veins to bulge. Varicose veins are more common in women than in men. The condition also runs in families. Pregnant women may get varicose veins because of hormonal changes and the extra pressure that the baby puts on the lower-stomach area. Varicose veins may also be caused by being severely overweight or by standing for long periods.

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Types | Stanford Health Care

Treatment Overview

Specialized Care for Women

Depending on the severity of the condition, treatment options may range from managing risk factors (through lifestyle changes and medications) to procedures or surgery to improve blood flow.

At Stanford, specialists at our Women’s Heart Health Clinic specifically focus on the health needs of women with PVD. We have vast experience successfully treating the disease and maintaining your best quality of life.

We recognize the unique concerns that women face, including: 

Diagnosis

At many other hospitals, doctors may not consider PVD testing in women, because historically, the condition was thought to affect men more than women. However, increasing research has shown that postmenopausal women have the same risk of the disease as men.

If PVD is overlooked, you may not receive the correct diagnosis, which could delay critical treatment. At Stanford, our doctors actively look for and successfully diagnose PVD in women using the latest noninvasive tests and technology.

Advanced stages

Many women with peripheral vascular disease receive the diagnosis later in life when the disease is more advanced. At that point, PVD may affect multiple limbs, and the risk for heart attack and stroke is greater.

Treatment

In advanced stages of PVD, women may not respond as well to treatment. That’s why we take a multidisciplinary approach to treating PVD here at Stanford. We bring together specialists from cardiology, orthopaedics, electrophysiology, and vascular surgery, among others, to determine the best care and treatment plan for you.

In general, the treatment options for PVD in men and women are the same: lifestyle modifications, medications, and surgery. To customize care for women, we may have to use a different combination of treatment options. Because women have smaller arteries and veins than men, we use special tools to treat women surgically. We also have ongoing clinical trials to help us learn more about how PVD affects women and the best treatment options for them.

Treatment Overview

Depending on the severity of the condition, treatment options may range from managing risk factors (through lifestyle changes and medications) to procedures or surgery to improve blood flow.

close Treatment Overview

Specialized Care for Women

At Stanford, specialists at our Women’s Heart Health Clinic specifically focus on the health needs of women with PVD. We have vast experience successfully treating the disease and maintaining your best quality of life.

We recognize the unique concerns that women face, including: 

Diagnosis

At many other hospitals, doctors may not consider PVD testing in women, because historically, the condition was thought to affect men more than women. However, increasing research has shown that postmenopausal women have the same risk of the disease as men.

If PVD is overlooked, you may not receive the correct diagnosis, which could delay critical treatment. At Stanford, our doctors actively look for and successfully diagnose PVD in women using the latest noninvasive tests and technology.

Advanced stages

Many women with peripheral vascular disease receive the diagnosis later in life when the disease is more advanced. At that point, PVD may affect multiple limbs, and the risk for heart attack and stroke is greater.

Treatment

In advanced stages of PVD, women may not respond as well to treatment. That’s why we take a multidisciplinary approach to treating PVD here at Stanford. We bring together specialists from cardiology, orthopaedics, electrophysiology, and vascular surgery, among others, to determine the best care and treatment plan for you.

In general, the treatment options for PVD in men and women are the same: lifestyle modifications, medications, and surgery. To customize care for women, we may have to use a different combination of treatment options. Because women have smaller arteries and veins than men, we use special tools to treat women surgically. We also have ongoing clinical trials to help us learn more about how PVD affects women and the best treatment options for them.

close Specialized Care for Women

Peripheral arterial disease (PAD) ᐈ Diagnosis and treatment

Description

Peripheral arterial disease (PAD) or endarteritis obliterans is an inflammatory disease that most often affects the arteries of the lower extremities, less often the upper ones, in which blood vessels narrow (atherosclerosis ) , normal blood flow is disturbed, leading to insufficient blood supply to the tissues of the lower extremities. PAD of the legs differs in three types depending on their localization: pelvic (iliac artery), femoral (femoral arteries) and lower leg (leg and foot arteries).

Thrombosis of the infrarenal abdominal aorta, known as Leriche’s syndrome, results in impaired circulation in both legs with pain in the buttocks and thighs. In men, impotence may develop. Peripheral arterial occlusion is quite common. Basically, up to 10% of the German population over the age of 50 suffer from this disease, but only in one third of cases the disease has severe symptoms, and it occurs four times more often in men than in women.

Symptoms

Depending on the type and severity of symptoms, PAD is classified into four stages according to Fontaine.

• Stage I: no complaints – the length of the distance passed by the patient is not limited.
• Stage II: if, as a result of spasm in the peripheral vessels, there is an insufficient supply of oxygen to the muscles, this can lead to the so-called intermittent claudication, characterized by pain in the lower extremities that occurs during walking and subsides when movement stops. At the same time, people are forced to make stops after a certain time while walking in order to get rid of pain. This stage is also divided into additional stages, depending on the distance traveled by the person.
• Stage IIa: Painless walking distance greater than 200 meters;
• Stage IIc: distance traveled by a person without pain – less than 200 meters;
• Stage III: sensation of pain at rest;
• Stage IV: destruction of tissues (necrosis) with the appearance of ulcers and wounds due to a large lack of oxygen in the tissues.

Along with pain, a number of other signs of circulatory disorders in the lower extremities appear: pallor of the skin of the extremities and a feeling of coldness in the legs, lack of pulsation in the affected extremities, muscle weakness during exercise, non-healing ulcers and wounds due to narrowing (stenosis ) blood vessels and insufficient supply of oxygen to the muscles.

Causes and risks

Atherosclerosis is considered to be the main cause of peripheral arterial disease. Much less often, PAD occurs on the basis of injuries, inflammatory diseases, embolism, inflammation of large blood vessels due to circulatory disorders. The main risk factors for the development of atherosclerosis and PAD include: smoking, diabetes mellitus (Diabetes mellitus), high blood pressure (arterial hypertension), metabolic disorders due to obesity. Among other risk factors, gender is also mentioned (men suffer from atherosclerosis more often than women), age, heredity, malnutrition (for example, excessive consumption of fats, meat and insufficient vegetables and fruits), overweight (obesity), lack of movement and physical loads.

Examination and diagnosis

In order to confirm the diagnosis in case of suspected PAD, the doctor needs to conduct a series of tests: a medical examination, including checking the color of the skin of the extremities, circulatory disorders, monitoring pulse rate, body temperature, listening for noise flow , sensory and motor testing, clinical studies (ergometry for determining the distance traveled on a treadmill, dopplerography, oscillography, color duplex ultrasound, digital angiography, CT angiography (CTA), magnetic resonance angiography (MRA) and laboratory tests for the determination of myoglobin SC and C-reactive protein (CRP).

Treatment

PAD should be treated according to the stages of the disease. At the first stage, conservative treatment is appropriate – first of all, the elimination of risk factors for cardiovascular diseases. A successful outcome in this case largely depends on the cooperation of patients with the doctor. The more active they are in their actions (for example, quitting smoking, controlling blood pressure, etc.), the more successful they will be able to stop the progression of the disease and avoid complications such as a heart attack or stroke. In the second stage, along with the adjustment of risk factors, drug treatment and an increase in the level of physical activity for the legs and blood vessels are recommended. Drug therapy often includes vasoactive agents such as cilostazol and antiplatelet drugs such as clopidogrel. Movement and walking play a decisive role in treatment. They stimulate the formation and development of collateral circulation, leading to an improvement in the blood supply to the affected lower extremities. In stages II – IV, in addition to drug therapy, revascularization methods of treatment can also be used, which means either open surgery or a catheter procedure. The latter involves the introduction of a catheter equipped with a stent into a narrowed or clogged blood vessel, which expands the patency of the artery and helps restore normal blood circulation. In surgery, bypass operations are often performed: sewing in an additional vessel to bypass the affected artery. In case of destruction of a large area of ​​tissue (stage IV of the disease), and when revascularization methods of treatment do not bring the desired results, as a rule, the last measure to save the patient’s life is used – amputation of the limb.

The course of the disease and prognosis

The course of the disease depends on many factors and, in particular, on how successfully one can cope with the main cause of vasoconstriction – atherosclerosis. To a large extent, it depends on the patient himself, on how actively and consistently he himself will deal with risk factors.