Peripheral Vascular disease (PVD)?
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis.
Are atherosclerosis and peripheral vascular disease related?
Atherosclerosis is a gradual process whereby hard cholesterol substances (plaques) are deposited in the walls of the arteries. This buildup of cholesterol plaques causes hardening of the artery walls and narrowing of the inner channel (lumen) of the artery. When this happens in the peripheral circulation, peripheral vascular disease is the result. The atherosclerosis process begins early in life (as early as teens in some people). When atherosclerosis is mild and the arteries are not substantially narrowed, atherosclerosis causes no symptoms. Therefore, many adults typically are unaware that their arteries are gradually accumulating cholesterol plaques. However, when atherosclerosis becomes advanced with aging, it can cause critical narrowing of the arteries resulting in tissue ischemia (lack of blood and oxygen).
Arteries that are narrowed by advanced atherosclerosis can cause diseases in different organs. For example, advanced atherosclerosis of the coronary arteries (arteries that supply heart muscles) can lead to angina and heart attacks. Advanced atherosclerosis of the carotid and cerebral arteries (arteries that supply blood to the brain) can lead to strokes and transient ischemic attacks (TIAs). Advanced atherosclerosis in the lower extremities can lead to painwhile walking or exercising (claudication), deficient wound healing, and/or leg ulcers.
Picture of Carotid Artery Disease and Plaque Buildup
Picture of a Heart Attack (Myocardial Infarction) – Buildup of Cholesterol Plaque and Blood Clot
Atherosclerosis is often generalized, meaning it affects arteries throughout the body. Therefore, patients with heart attacks are also more likely to develop strokes and peripheral vascular disease, and vice versa.
What are the signs and symptoms of peripheral artery disease (PVD)?
Approximately half of people with peripheral artery disease do not experience any symptoms. For patients with symptoms, the most common symptoms are intermittent claudication and rest pain.
- Intermittent claudication refers to arm or leg pain or cramping in the arms or legs that occurs with exercise and goes away with rest. The severity and location of the pain of intermittent claudication vary depending upon the location and extent of blockage of the involved artery. The most common location of intermittent claudication is the calf muscle of the leg, leading to calf or leg pain while walking. The pain in the calf muscle occurs only during exercise such as walking, and the pain steadily increases with continued walking until the patient has to stop due to intolerable pain. Then the pain quickly subsides during rest. Intermittent claudication can affect one or both legs.
- Rest pain in the legs occurs when the artery occlusion is so critical that there is not enough blood and oxygen supply to the legs even at rest and represents a more serious form of the condition. The pain typically affects the feet, is usually severe, and occurs at night when the patient is lying down, face up.
Other symptoms and signs of peripheral artery disease include:
- Numbness of the legs or feet
- Weakness and atrophy (diminished size and strength) of the calf muscle
- A feeling of coldness in the legs or feet
- Changes in color of the feet; feet turn pale when they are elevated, and turn dusky red in dependent position
- Hair loss over the top of the feet and thickening of the toenails
- Poor wound healing in the legs or feet
- Painful ulcers and/or gangrene in areas of the feet where blood supply is lost; typically in the toes
What are the management and treatment guidelines for peripheral vascular disease (PVD)?
Treatment goals for peripheral artery disease include:
- Relieve the pain of intermittent claudication.
- Improve exercise tolerance by increasing the walking distance before the onset of claudication.
- Prevent critical artery occlusion that can lead to foot ulcers, gangrene, and amputation.
- Prevent heart attacks and strokes.
Treatment of peripheral artery disease includes lifestyle measures, supervised exercises, medications, angioplasty, and surgery.
Lifestyle changes
- Smoking cessation eliminates a major risk factor for disease progression, and it lowers the incidences of pain at rest and amputations. Smoking cessation also is important to prevent heart attacks and strokes.
- A healthy diet can help lower blood cholesterol and other lipid levels and may help control blood pressure.
- Keep other risk factors, such as diabetes, lipid levels, and blood pressure under control by following medical advice regarding medications and lifestyle changes.
Supervised exercise
Proper exercise can condition the muscles to use oxygen effectively and can speed the development of collateral circulation. Clinical trials have shown that regular supervised exercise can reduce symptoms of intermittent claudication and allow individuals to walk longer before the onset of claudication. Ideally, your doctor should prescribe an exercise program tailored to your specific needs.
Rehabilitation programs supervised by healthcare professionals such as nurses or physical therapists may help. Exercise at least three times a week, each session lasting longer than 30 to 45 minutes for the best results. Exercise usually involves walking on a monitored treadmill until claudication develops; walking time is then gradually increased with each session. Patients are also monitored for the development of chest pain or heart rhythm irregularities during exercise.
Post a comment