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Peripheral Vascular Disease (PVD) >
What is peripheral vascular disease?
Peripheral vascular disease is a condition in which blood flow to the arms, legs or other parts of the body becomes restricted. This can lead to pain in the affected limbs, and in the most severe cases, gangrene. It is also referred to as peripheral arterial disease as it mainly just affects the arteries.
Most importantly, peripheral vascular disease is strongly associated with coronary artery disease – a condition in which the blood supply to the heart becomes restricted, increasing the risk of heart attack.
What causes peripheral vascular disease?
Peripheral vascular disease is usually caused by narrowing of the arteries, through a process called atherosclerosis. In atherosclerosis, there is a gradual build-up of plaque (fatty deposits) in the lining of the arteries. This results in the arteries becoming narrowed, leading to a restriction in the blood flow. This process also increases the risk of a blood clot forming.
The rate at which the plaques develop depends on a number of factors, such as a person’s genes, your blood pressure, your cholesterol level, and whether or not you smoke.
What are the risk factors?
The risk factors for developing peripheral vascular disease are the same as those for atherosclerosis in general, i.e.:
- Family history of disease
- High blood pressure
- Smoking
- Diabetes
- High Cholesterol
- Being overweight
What are the symptoms?
Peripheral vascular disease most commonly affects the legs – the main symptom is cramping pains in the muscles of the legs on any exertion (this is called intermittent claudication). This can also happen in the arms.
If the blockage in the arteries becomes more severe, you may experience pain even when at rest. This normally occurs in the feet and at night-time, when you are lying down. This can lead to foot ulcers and even gangrene. In extreme cases, amputation may be necessary.
Peripheral vascular disease can also affect the kidneys, leading to the development of high blood pressure and renal failure.
Many people with peripheral vascular disease do not even realise they have it, as many elderly people attribute their symptoms to ageing. It is therefore important to be on the look-out for symptoms, especially if you think you may be at risk.
Why does peripheral vascular disease increase the risk of heart attack?
Peripheral vascular disease can be a sign that you may also have developed, or be at risk of developing, atherosclerosis in your coronary arteries - those arteries that supply blood to the heart. This is called coronary artery disease (also known as coronary heart disease). There is also a greater chance that you could have developed atherosclerosis in the arteries of your brain – which can lead to stroke. In addition, a clot formed in one of your peripheral arteries may travel to the brain, causing a stroke. Because of this, people with peripheral vascular disease have a six to sevenfold increased risk of heart attack or stroke.
What should I do if I have symptoms?
If you suspect you have symptoms associated with peripheral vascular disease, or you think you may be at risk, visit your family doctor (GP). Early treatment can prevent the disease from progressing.
Your doctor will conduct a physical examination to look for signs of the disease, and will be able to decide if you need further assessment. The doctor may carry out a special type of blood pressure test called an ankle-brachial index. This tests the difference in blood pressure between your arm and your ankle, so that the doctor can see if there is a problem in blood flow to your legs.
In some cases, the doctor may decide to refer you to the hospital to have more specialist imaging tests carried out, to find out the extent of the damage in your arteries.
What is the treatment?
If you are diagnosed with peripheral vascular disease, the first and most important step is normally to make some changes to your lifestyle. These could include stopping smoking, making sure any other conditions you have – such as diabetes and blood pressure are under control, and making changes to your diet to reduce cholesterol level. Regular exercise is very important as this can help to improve the circulation in your legs.
Your doctor may prescribe you with various types of medications. These may include medication to prevent blood clots and reduce your risk of stroke and heart attack (e.g., aspirin), a type of drug known as a statin to lower your cholesterol and drugs to control your blood pressure. You may also be given a drug specifically to improve the blood flow to your legs, and reduce the pain when walking.
Sometimes, if your artery is severely blocked or if medication isn’t helping, you may need a procedure called an angioplasty. This involves inserting a catheter into the artery to open it up. In some cases, surgery may also be necessary to bypass the artery that has been blocked. This is done by inserting a new blood vessel (a ‘graft’) to create a detour around the affected artery.