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.