Peripheral Vascular Disease
Peripheral vascular disease, also known as PVD or peripheral arterial disease, is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged with plaque. This interferes with the normal flow of blood. PVD sometimes causes pain while walking or exercising, but often causes no symptoms at all. PVD affects 10 million people in the United States including one in every 20 adults over the age of 50. PVD increases the risk for heart disease, stroke and loss of limbs.
Because PVD increases the risk of heart disease, stroke and loss of limbs, timely detection and treatment are important.
Causes of PVD
The most common cause of PVD is atherosclerosis (often called hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called “plaque” that clogs the blood vessels. In some cases, PVD may be caused by blood clots that lodge in the arteries and restrict blood flow.
You are at increased risk for PVD if you are:
- Over the age of 50
- Have ever smoked or smoke now
- Have diabetes
- Are overweight and/or have a sedentary lifestyle
- Have a personal history of high blood pressure, heart disease, or other vascular disease
- Have elevated cholesterol levels
- Have a family history of PVD
Symptoms of PVD
- Painful cramping in the leg or hip that occurs when walking or exercising, and disappears when the person stops the activity. This pain is known as intermittent claudication.
- Some may experience numbness, tingling or weakness in the lower legs or feet with ambulation.
- When PVD is severe, pain in feet or toes when resting
- Ulcers or sores on leg or foot that won’t heal
- Patients may also note coldness in lower legs or feet
Screening for PVD
Because atherosclerosis is a systemic disease, people with PVD are likely to have blocked arteries in other areas of the body. Thus, people with PVD are at increased risk for heart disease, aortic aneurysms and stroke.The Society of Interventional Radiology recommends greater screening efforts through the use of the ankle brachial index (ABI) test. This simple, painless test compares the blood pressure in the legs to the blood pressure in the arms to determine how well the blood is flowing and if further testing is needed. Each September, during Peripheral Vascular Disease Month, interventional radiologists participate in Legs For Life, a nationwide screening program sponsored by the Society of Interventional Radiology.
Treatment Options
If PVD does not improve with lifestyle change such as smoking cessation, structured exercise and cholesterol lowering programs, AAR interventional radiologists can evaluate the condition using non-invasive techniques or angiography. They also can provide comprehensive treatment for PVD including counseling on how to prevent worsening and conservative management strategies. When necessary, they can treat PVD with interventional procedures, such as angioplasty and stent placement.
- Angiography
Angiography is an exam of the arteries and veins to diagnose blockages and other blood vessel problems. An interventional radiologist performs this procedure, also called an angiogram or venogram, on an out-patient basis. During the angiogram, the doctor inserts a thin tube, called a catheter, into the artery through a small incision in the skin. A substance called a contrast agent, or X-ray dye, is injected to make the blood vessels visible on the X-ray. One of the most common reasons for angiography is to see if there is a blockage or narrowing in a blood vessel that may interfere with the normal flow of blood through the body. In many cases, the interventional radiologist can treat a blocked blood vessel without surgery at the same time the angiogram is performed using techniques called angioplasty and thrombolysis. - Balloon Angioplasty and Stent Placement
Angioplasty is a technique for opening up narrowed blood vessels, such as in the legs or the neck. A very small balloon attached to a thin tube (catheter) is inserted into a blood vessel through a small nick in the skin. The catheter is threaded under X-ray guidance to the site of the narrowed artery. The balloon is inflated to open the artery. Sometimes, a small metal scaffold called a stent is also inserted to hold the blood vessel open. Angioplasty and stents often replace by-pass graft surgery in treating artery problems. - Thrombolytic Therapy
Thrombolytic therapy is an interventional technique that can open arteries and veins blocked by a blood clot. During angiography, the interventional radiologist identifies the exact location of the blood clot and injects thrombolytic (clot-busting) drugs directly into the clot to dissolve it and to restore blood flow. This treatment is often followed by angioplasty or stenting to hold open the treated section of artery or vein. This technique is usually used for treatment of arteries affected by PVD and for dissolving leg vein clots (deep venous thrombosis). Thrombolysis can also sometimes be used to treat patients who are having an acute (new) stroke, restoring blood flow to the brain before permanent brain damage occurs.