PERIPHERAL VASCULAR DISEASE (PVD)

The circulatory system is made up of arteries and veins which carry blood to and from all your organs and tissues.  The arteries carry the fresh oxygenated blood from the heart and the veins carry blood back to the heart and lungs.

Healthy arteries have a smooth lining. However, as people age they may develop a buildup of fat, cholesterol and calcium in the wall of the artery. This is called plaque and the condition is called Atherosclerosis or “hardening of the arteries”.  The lining becomes irregular and ultimately the artery can block off. Also, little pieces of this abnormal fatty build up can break loose and get carried down the artery to lodge elsewhere in the system causing a blockage at that site also.

When it affects the heart arteries (coronary arteries) it can lead to angina or heart attack. When it affects the arteries to the brain it can cause TIA or stroke. When it affects the arteries of the leg, it may cause claudication or gangrene.

Certain risk factors will increase the risk of atherosclerosis:

  • High cholesterol levels
  • High triglyceride levels
  • Smoking
  • High Blood Pressure (Hypertension)
  • Diabetes
  • Family history of PVD or heart disease
  • Obesity
  • Lack of exercise
  • Stroke

HOW DO I KNOW WHETHER I HAVE PVD?

In most patients PVD is silent and causes no symptoms. However, when the leg arteries get significantly narrowed or blocked certain tell-tale symptoms will occur. The first and most important symptom is referred to as claudication. This is a cramping pain, dull ache or sense of tiredness in the calves or buttocks when one walks a specific distance and goes away when one stops walking and rests. It comes on again when one resumes walking.

As the disease progresses severe pain may occur even at rest. This is usually noticed at night when one lies down to go to sleep. In bed, we no longer have gravity helping the blood get to the feet and so they start to hurt. Patients will often remark that the pain eases somewhat when they get out of bed and stand or walk around. This is an important symptom since it implies very severe impairment to blood flow. If untreated, gangrene or death of the toes or feet can eventually result. Similarly, cuts or scrapes may not heal and lead to ulceration.

 

When the doctor examines patients with PVD certain findings may be discovered:

  • Absent pulses in the foot or leg
  • A noise in the artery caused by turbulent blood flow. This is called a bruit.
  • Cool temperature of the foot or leg
  • Pale colour when the foot is elevated
  • Decreased hair or tissue fat
  • Open sores or black areas of gangrene

WHAT TESTS ARE THERE FOR PVD?

Nowadays simple painless tests can be performed to diagnose PVD. These tests are usually performed in a Vascular Laboratory by a specialised vascular sonographer. The quality of vascular ultrasound is variable so it is important to request that your test be performed by a vascular sonographer.

Blood Pressure or Plethysmography tests: The simplest test is called the Ankle/brachial Index or ABI. Using a Doppler that is a special hand-held device much like an electronic stethoscope, the blood pressure in the ankle is compared to that in the arm.

Duplex ultrasound: In order to get a picture of where the blockage is, very advanced machines using ultrasound can produce pictures showing the blood vessels and the blood flowing through them.  The test is called a duplex or ultrasound scan.

CT angiography provides 3D imaging of blood vessels.

Angiogram

RISK FACTORS

We cannot completely prevent or cure atherosclerosis but limiting the risk factors is important in slowing down its progress and stabilising the plaque.

  • Diabetes
  • Smoking
  • High Blood Pressure
  • Hyperlipidemia
  • Obesity
  • Male gender
  • Age over 50

TREATMENT OF PAD

Endovascular procedures:

Endovascular procedures:

In some patients PAD must be treated invasively. This implies surgery or some of the minimally invasive procedures where the artery is treated from inside or endovascularly.

It should be realized that these procedures are still invasive in that a needle, wire or balloon has to be inserted into the artery. Furthermore, complications can occur that may be serious. On the other hand these are usually rare and most patients can go home within 24 hours of the procedure.

Balloon Angioplasty: This procedure can be performed for short areas of narrowing or occlusion. A balloon is threaded into the artery and inflated thus breaking the plaque and widening the artery. The balloon is then removed.

Stents: after balloon angioplasty some arteries will tend to collapse again. A stent is a small metal scaffold that is placed in the artery to prevent this narrowing. Unfortunately, in some patients the body forms scar tissue around the stent and this scar can also block the artery again.

Thrombolytic therapy: Sometimes blood clot can form on plaque causing a sudden worsening of the circulation. In some patients the doctor can pass a catheter into the clot and clean the clot out with a special medication.

Surgical procedures:

Endarterectomy / Bypass

Information available soon.