Peripheral Vascular Disease (PVD)
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. 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:
In PVD, blood vessels become narrowed and blood flow decreases. This can be due to 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.
Peripheral arterial disease (PAD) develops only in the arteries, which carry oxygen-rich blood away from the heart. According to the CDC, approximately 12 to 20 percent of people over age 60 develop PAD, about 8.5 million people in the United States. PAD is the most common form of PVD, so the terms are often used to mean the same condition.
PVD is also known as:
- arteriosclerosis obliterans
- arterial insufficiency of the legs
- 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.
Your vessels naturally widen and narrow in response to your environment. But in functional PVD, your vessels exaggerate their response. Raynaud’s disease, when stress and temperatures affect your blood flow, is an example of functional PVD.
The most common causes of functional PVD are:
- emotional stress
- cold temperatures
- operating vibrating machinery or tools
Organic PVD means there’s change in the structure of your blood vessels. For example, the plaque buildup from arteriosclerosis can cause your blood vessels to narrow. The primary causes of organic PVD are:
Additional causes of organic PVD include extreme injuries, muscles or ligaments with abnormal structures, blood vessel inflammation, and infection.
There are numerous risk factors for PVD.
You’re at higher risk for PVD if you:
- are over age 50
- are overweight
- have abnormal cholesterol
- have a history of cerebrovascular disease or stroke
- have heart disease
- have diabetes
- have a family history of high cholesterol, high blood pressure, or PVD
- have high blood pressure
- have kidney disease on hemodialysis
Lifestyle choices that can increase your risk of developing PVD include:
- not engaging in physical exercise
- poor eating habits
- drug use
Breakdown of risks for PVD around the world
For many people, the first signs of PVD begin slowly and irregularly. You may feel discomfort like fatigue and cramping in your legs and feet that gets worse with physical activity due to the lack of blood flow.
Other symptoms of PVD include:
|Area of pain||Symptoms|
|legs||reduced hair growth, cramps when lying in bed|
|legs and arms||turn reddish blue or pale|
|legs and feet||thin or pale skin, weak pulses, wounds, or ulcers that won’t heal|
|toes||blue color, severe burning, or thick and opaque toe nails|
|muscles||feel numb or heavy|
Tell your doctor if you’re experiencing any symptoms of PVD. These symptoms are commonly brushed aside as the results of aging, but 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.
The most common symptom of PVD and PAD is claudication. Claudication is lower limb muscle pain when walking. You may notice the pain when you are walking faster or for long distances. It usually goes away after some rest. When the pain comes back, it may take the same amount of time to go away.
Claudication occurs when there’s not enough blood flow to the muscles you’re using. In PVD, the narrowed vessels can only supply a limited amount of blood. This causes more problems during activity than at rest.
As your PAD progresses, symptoms will occur more frequently and get worse. Eventually, you may even experience pain and fatigue during rest. Ask your doctor about treatments to help improve blood flow and decrease pain.
Complications from undiagnosed and untreated PVD can be serious and even life-threatening. Restricted blood flow of PVD can be a warning sign of other forms of vascular disease.
Complications of PVD can include:
- tissue death, which can lead to limb amputation
- pale skin
- pain at rest and with movement
- severe pain that restricts mobility
- wounds that don’t heal
- life-threatening infections of the bones and blood stream
The most serious complications involve the arteries bringing blood to the heart and brain. When these become clogged, it can lead to heart attack, stroke, or death.
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. If your doctor hears a whooshing sound through their stethoscope, it could mean a narrowed blood vessel.
They may order more specific tests to diagnose PVD. These tests include:
|Doppler ultrasound||sound waves for imaging||blood flow in your vessels|
|ankle-brachial index (ABI)||ultrasound and blood pressure cuff around your ankle and arm, measured before and during exercise||comparison of blood pressure readings in your leg and arm, as lower pressure in your leg could indicate a blockage|
|angiography||injected dye in a catheter that’s guided through the artery||the flow of dye through blood vessels to diagnose the clogged artery|
|magnetic resonance angiography (MRA)||magnetic field imaging||image of blood vessels to diagnose blockage|
|computerized tomography angiography (CTA)||X-ray imaging||image of blood vessels to diagnose blockage|
The two main goals of PVD treatment is to stop the disease from progressing and to help you manage your pain and symptoms so you can remain active. The treatments will also lower your risk for serious complications.
If you smoke, you should quit. 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.
If lifestyle changes alone aren’t enough, you may need medication. Medications for PVD 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
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.
If diagnosed early, many cases of PVD will respond to lifestyle treatments. One way to measure improvement is to measure how far you can walk without pain. With effective treatment, you should be able to gradually increase the distance.
Contact your doctor if your symptoms get worse or you experience any of the following:
- legs look pale or blue
- legs become cold
- chest pain accompanies leg pain
- legs become red, swollen, or hot
- new sores or ulcers develop and do no heal
- fever, chills, weakness, or other signs of infection
How PVD impacts people around the world
You can reduce your risk of developing PVD through a healthy lifestyle. This includes:
- avoiding smoking
- controlling your blood sugar, if you have diabetes
- setting an exercise goal of 30 minutes a day, five times a week
- working to lower cholesterol and blood pressure
- eating a healthy diet that’s low in saturated fat
- keeping your weight at a healthy level
Talk to your doctor if you experience symptoms of PVD. Early diagnosis can help you and your doctor find ways to reduce your symptoms and increase the effectiveness of your treatment.
Written by: Ann Giorgi
Medically reviewed on Sep 06, 2016 by Judith Marcin, MD