PERIPHERAL VASCULAR DISEASE

Peripheral vascular disease (PVD) is a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm. In PVD, blood vessels become narrowed and blood flow decreases.This can happen in your arteries or veins. PVD typically causes pain and fatigue, often in your legs, and especially during exercise. The pain usually improves with rest.

It can also affect the vessels that supply blood and oxygen to your arms, stomach and intestines and kidneys.

PVD can be cause by arteriosclerosis, or “hardening of the arteries,” or it can be caused by blood vessel spasms. In arteriosclerosis, plaques build up in a vessel and limit the flow of blood and oxygen to your organs and limbs. As plaque growth progresses, clots may develop and completely block the artery. This can lead to organ damage and loss of fingers, toes, or limbs, if left untreated.

PVD is also known as:

  • arteriosclerosis obliterans
  • arterial insufficiency of the legs
  • claudication
  • intermittent claudication

The two main types of PVD are functional and organic PVD.

  • Functional PVD means there’s no physical damage to your blood vessels’ structure. Instead, your vessels widen and narrow in response other factors like brain signals and temperature changes. The narrowing causes blood flow to decrease.
  • Organic PVD involves changes in blood vessel structure like inflammation, plaques, and tissue damage.

Symptoms of PVD may include:

  • fatigue and cramping in your legs
  • reduced hair growth or cramps in your legs when lying in bed
  • legs and arms turn reddish blue or pale
  • legs and feet have thin or pale skin, weak pulses, wounds or ulcers that won’t heal
  • toes have blue color, severe burning, or thick and opaque toe nails
  • muscles feel numb or heavy
  • Claudication- Claudication is lower limb muscle pain when walking. It occurs when there’s not enough blood flow to the muscles you’re using

These symptoms are commonly brushed aside as the results of aging . Tell your doctor if you’re experiencing any symptoms of PVD because delayed diagnosis and treatment can cause further complications. In extreme cases of blood loss, gangrene, or dead tissue, can occur. If you suddenly develop a cold, painful, pale limb with weak or no pulses, this is a medical emergency. You will require treatment as soon as possible in order to avoid severe complications and amputation.

DIAGNOSIS

Early diagnosis is the first step to successful treatment and it can prevent life-threatening complications.

Tell your doctor if you have any of the classic symptoms of PVD, such as claudication. Your doctor will also ask about your medical history and perform a physical exam. The physical exam can include measuring the pulses in your legs and feet.

They may order more specific tests to diagnose PVD. These tests include:

  • Doppler ultrasound- It uses sound waves for imaging and that looks on the blood flow in your vessels.
  • Ankle-brachial index (ABI)- During this test, ultrasound and blood pressure cuff around ankle and arm, measured before and during exercise.
  • Angiography- In this test a dye is injected in a catheter that’s guided through the artery. The dye will diagnosed clogged artery.
  • Magnetic Resonance angiography (MRA)- It uses magnetic field imaging that show image of blood vessels to diagnose blockage.
  • Computerized tomography angiography (CTA)- It uses X-ray imaging that shows image of blood vessels to diagnose blockage

 

TREATMENT

The two main goals of PVD treatment:

  • to stop the disease from progressing
  • to help you manage your pain and symptoms so you can remain active. The treatments will also lower your risk for serious complications.

Lifestyle modifications is typically involve in the first-line treatment. Your doctor will suggest a regular exercise program that includes walking, a balanced diet, and losing weight.

You should quit smoking. Smoking directly causes reduced blood flow in vessels. It also causes PVD to get worse, as well as increasing your risk of heart attack and stroke.

Medication. You may need medication if lifestyle changes alone aren’t enough. These include:

  • cilostazol or pentoxifylline to increase blood flow and relieve symptoms of claudication
  • clopidogrel or daily aspirin to reduce blood clotting
  • atorvastatin, simvastatin, or other statins to lower high cholesterol
  • angiotensin-converting enzyme (ACE) inhibitors to lower high blood pressure
  • diabetes medication to control blood sugar, if you have diabetes

Surgery

Significant artery blockages may require surgery like angioplasty or vascular surgery.

  • Angioplasty is when your doctor inserts a catheter or long tube into your artery. A balloon on the tip of the catheter inflates and opens up the artery. In some cases, your doctor will place a small wire tube in the artery, called a stent, to keep it open.
  • Vascular surgery allows for blood to bypass the narrow area through vein grafting.

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