Peripheral Vascular Pathology


Peripheral vascular diseases (PVDs) are circulation disorders that affect blood vessels outside of the heart and brain. PVD typically strikes the veins and arteries that supply the arms, legs, and organs located below your stomach. These are the blood vessels that are distant from the heart. They are known as peripheral vessels.

In PVD, blood vessels are narrowed. Narrowing is usually caused by arteriosclerosis. Arteriosclerosis is a condition where plaque builds up inside a vessel. It is also called “hardening of the arteries.” Plaque decreases the amount of blood and oxygen supplied to the arms and legs.

As plaque growth progresses, clots may develop. This further restricts the affected vessel. Eventually, arteries can become obstructed.

PVD that develops only in the arteries is called peripheral arterial disease (PAD). This is the most common form of PVD. Approximately 12 to 20 percent of people over age 65 have PAD.

PVD that develops in the deep veins in the body is usually caused from claudication and is called deep vein thrombosis (DVT).

PVD and PAD are often used to mean the same condition that affects the arteries. PVD may also be referred to as:

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

Types of PVD

Functional PVD: This does not involve physical problems in the blood vessels. It causes incidental or short-term symptoms. Usually these spasms occur erratically.

Organic PVD: This involves changes in blood vessel structure. This type of PVD causes inflammation, tissue damage, and blockages.

Causes of PVD

Functional PVD
The body responds to certain external stimuli by restricting blood flow to the peripheral vessels. The most common causes of functional PVDs are:

  • emotional stress
  • smoking
  • cold temperatures
  • operating vibrating machinery or tools

Organic PVD

Physical changes can affect the structure of blood vessels. For example, arteriosclerosis can cause plaque buildup. The primary causes of such organic PVDs are:

  • smoking
  • high blood pressure
  • diabetes
  • high cholesterol

Additional causes of organic PVDs include:

  • injury to extremities
  • muscles or ligaments with abnormal structures
  • infection
  • coronary artery disease

Symptoms of PVD

For many people, there are no symptoms of PVD. For others, the first signs of PVD begin slowly and irregularly. You may feel discomfort in your legs and feet. You may experience:

  • painful cramping
  • achiness
  • fatigue
  • burning

Typically, you will feel these sensations when you walk. You may first notice them when walking quicker, with more exertion, or for long distances. The pain will intensify with activity and subside when you rest. This is called intermittent claudication.

Intermittent claudication occurs because your muscles need more blood flow during activity. In PVD, the vessels are narrowed with plaque. They can only supply a limited amount of blood. This causes more problems during activity than at rest. Lack of blood causes pain and discomfort.

As your PVD progresses, symptoms will occur more frequently. It will require less exertion to bring them on. Eventually, you will experience leg pain and fatigue even at rest.

Additional symptoms may occur as a result of reduced blood supply. With PVD, you may have:

  • skin changes on your legs and feet (thinning, , shiny, or paleness may occur)
  • weak pulses in your legs and feet
  • gangrene—tissue death caused by lack of blood flow
  • wounds or ulcers on the legs and feet that won’t heal
  • reduced hair growth on your legs
  • toes that turn blue
  • severe burning pain in your toes
  • leg cramps and pain when you are lying in bed
  • muscles that feel numb or heavy
  • arms and legs that are reddish blue
  • toenails that are thick and opaque

Treatment of PVD

There are two main goals of PVD treatment. The first is to control pain and symptoms. This allows you to remain active. The second is to stop the disease from progressing. This will lower your risk of serious and life-threatening complications.

Treatment typically includes lifestyle modifications. You will need to:

  • stop smoking
  • commit to a regular exercise program that includes walking
  • eat a balanced diet with proper nutrition
  • lose weight
  • treat conditions such as diabetes, high blood pressure, or high cholesterol

Smoking cessation is one of the most important ways to treat PVD. Smoking directly causes reduced blood flow in vessels.

If lifestyle changes don’t control your PVD, you may need medication. Medications for PVD include:

  • cilostazol or pentoxifylline—to increase blood flow to the legs, ease leg pain, and relieve symptoms of claudication
  • clopidrogel or daily aspirin—to reduce risk of blood clots. Clots could cut off the blood supply to a limb. This puts you at risk of amputation.
  • 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. There are several surgical treatments for PVD.

Angioplasty is performed by inserting a catheter or long tube into the blocked artery. A balloon on the tip of the catheter is inflated. This opens the blockage. In some cases a stent is placed in the artery to keep it open. A stent is a small wire tube.

Vascular surgery bypasses the blocked vein. A vein from another part of your body, or a synthetic graft, is attached to the affected vein. This allows blood to bypass the narrow area.

Source: Healthline


Charles White, DPM
Foot & Ankle Surgery / Podiatry

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