The term peripheral Vascular Disease PVD is commonly also referred as Peripheral Arterial Disease or PAD. The condition means narrowing or occlusion by atherosclerotic plaques of the arteries adjacent to heart and brain. Increase blood cholesterol levels, diabetes, smoking, inactivity, hypertension and overweight and obesity are some of the risk factors increasing the risk for developing PADs and PVDs in people.
People above the age of 50 are more prone to getting this health related complication due to the presence of various lifestyle risk factors that are seen today. The symptoms of the condition majorly depend upon the location and extent of the blocked arteries. The major risk factors include elevated blood cholesterol, diabetes, smoking, hypertension, inactivity and obesity.
The condition refers to the disease of the blood vessels arteries and veins located outside the heart and brain. While the cause of developing this condition is many; doctors might come up with a diagnosis stating that it is the condition that is generally observed when the arteries supply blood to the internal organs, arms and legs.
The condition is highly related to atherosclerosis. It is a gradual process whereby hard cholesterol substances are seen deposited on the walls of the arteries. These are known as cholesterol plaques, cause hardening of the arterial walls and narrowing of the inner channel of the artery.
How does atherosclerosis cause the disease?
There are two ways artherosclerosis causing the disease. The condition limits the ability of the narrowed arteries to increase delivery of blood and oxygen to tissues during the periods of exertion. Complete obstruction of an artery by the forms of blood clots like embolus or thrombus. Exertional angina and intermittent claudication are two examples of insufficient delivery of blood and oxygen to meet the demand of tissue.
In most of the cases, the person experiences stroke and heart attack of death of tissue caused by complete artery obstruction by blood clots. There are many similarities in the condition. Lack of blood and oxygen causes chest pain or exertional angina. This condition however typically subsides when the patient rests.
This is normally observed when the narrowed arteries in the lower extremities. These patients experience pain in the calf muscles that will only subside after resting.
Who are at the risk for Peripheral Artery Disease?
Peripheral artery disease is a common condition affecting around ten million adults in the US. About 5% of people over the age of 50 years, the arterial complication is just more common in men compared to women and most often it found in older men over the age of 50 years. The risk factors include;
- High blood levels of bad cholesterol or LDL cholesterol and triglycerides
- Low blood levels of good cholesterol or HDL
- Cigarette smoking
- Diabetes mellitus (both type 1 and type 2 diabetes)
- High blood pressure (hypertension) or those with a family history of hypertension
- A family history of atherosclerotic disease
- Chronic renal failure
- Overweight or obesity
- Physical inactivity
Signs and symptoms of Peripheral Artery Disease
The common symptoms are the intermittent claudication and rest pain. The common symptoms include intermittent claudication refers to arm or leg pain or cramping in the arms or legs occur with exercise and subsides with rest. The severity and location of the pain of intermittent claudication affects one or both legs. Other common symptoms include;
- Numbness of the extremities
- A feeling of coldness in the legs and feet
- Weakness and atropy of the calf muscles
- Change in color of feet when feet turns pale when elevated and turns dusky red in dependent position
- Loss of hair of the feet and thickening of the toenails
- Painful ulcers and gangrene in tissue where there is critical ischemia in the toes.
How is PADs diagnosed?
A proper physical examination, the doctor looks for signs that are indicative of PADs (Peripheral artery disease) including weak or absent artery pulse in the extremities. The doctor looks out for a specific sound called as bruits which can be heard over the arteries with the help of stethoscope. Similarly, changes in blood pressure in the limbs and rests during exercise, especially while carrying out a treadmill test is observed as a skin color and nail change due to the tissue ischemia.
The methods used for complete PADs diagnosis are Doppler ultrasound, Duplex ultrasound, Angiography and MRI (Magnetic Resonance imaging)
X-ray angiography is invasive with potential side-effects which can cause injury to blood vessels and contrast dye reaction. The method is not useful in diagnosing PADs; the method is also used with severe peripheral artery disease symptoms considered for angioplasty or surgery.
Treatments for PADs (Peripheral Artery Disease)
The treatment goals basically emphasizes on making the effective lifestyle changes by adhering to healthy routine habits, cessation of smoking, adherence to healthy diet by lowering blood cholesterol and other lipid level helps control blood pressure. Keeping up the other risk factors of diabetes, lipid levels and maintaining the blood pressure levels to normal.
Trying out supervised exercising measures by improving the condition of muscles to use oxygen effectively and speeding up development of collateral circulation. These are some of the non-medicinal treatments to be carried out to keep the risks at a bay.
The medications advised for overcoming the troubles of PADs are antiplatelet medications like aspirin, clopidogrel, anticoagulant medications like Coumadin, cholesterol lowering drugs, Cilostazol pletal which helps in increasing physical activity by causing dilation of the arteries and increasing supply of oxygenated blood to be delivered to arms and legs, pentoxifylline and drugs controlling hypertension. Surgical treatments for peripheral artery disease involves bypass performed by a vascular surgeon or endarterectomy, in many of the cases, angioplasty is also carried out. Bypass surgery involves using a vein from the body or a portion of synthetic vessel to create a detour around the blockage.