William H. Edwards, Jr., MD: vascular surgeon
Stanley O. Snyder, MD: vascular surgeon
SAINT THOMAS HOSPITAL
TOPIC: Advances in Vascular Disease
Monday, November 8, 2010
News notes via www.webmd.com
Peripheral Vascular Disease Overview
The circulatory system consists of 2 types of blood vessels: arteries and veins. These are tubular structures that carry the blood throughout the body.
- Arteries carry oxygen- and nutrient-rich blood from the heart to the organs and cells.
- Veins carry oxygen-depleted blood and wastes through the kidneys, liver, and lungs, where wastes are filtered out and removed from the body. The venous blood is then again filled with oxygen in the lungs and returned back to the heart.
- The two are interconnected by small weblike vessels called capillaries.
Peripheral vascular disease refers to any disease or disorder of the circulatory system outside of the brain and heart.
- Although the term peripheral vascular disease can include any disorder that affects any of the blood vessels, it often is used as a synonym for peripheral artery disease.
- Peripheral vascular disease is the most common disease of the arteries.
- It is caused by build-up of fatty material within the vessels, called atherosclerosis.
- Another name for this condition is arteriosclerosis, or hardening of the arteries.
- This is gradual process in which the artery gradually becomes blocked, narrowed, or weakened.
- When this condition affects the arteries of the heart, it is called coronary heart disease (coronary artery disease).
Atherosclerosis is known for affecting the arteries of the heart (coronary arteries) and the brain (carotid arteries). Of the peripheral arteries, those of the legs are most often affected. Other arteries frequently affected by atherosclerosis include those supplying blood to the kidneys or arms.
- When an artery is blocked or narrowed, the part of the body supplied by that artery does not get enough blood/oxygen. Medical professionals call this ischemia.
- This can cause various symptoms depending on which organ system is affected. The symptoms range from pain, cold feet, and bluish discoloration to stroke or gangrene; if it is not reversed, the body part affected is injured and eventually starts to die. It is important to detect the narrowed artery before damage occurs. The pulses in the arm or leg are decreased or absent, indicating a lack of arterial blood flow.
Peripheral vascular disease is a very common condition in the United States.
- It occurs mostly in people older than 50 years. Peripheral vascular disease is a leading cause of disability among people older than 50 years and in those with diabetes.
- About 10 million people in the United States have peripheral vascular disease, which translates to about 5% of people older than 50 years.
- The number of people with the condition is expected to grow as the population ages.
- Men are slightly more likely than women to have peripheral vascular disease.
- Peripheral vascular disease is more common in smokers, and the combination of diabetes and smoking almost always results in more severe disease.
About half of people with peripheral vascular disease do not have symptoms. Of those who do, another half do not tell their health care providers.
- Many people seem to think that this is a normal part of aging, and that nothing can be done or that the only alternative is surgery. Today, however, surgery is only one of several effective treatments available for peripheral vascular disease.
- Treating peripheral vascular disease medically is the best way to prevent worsening of the condition or complications. This is especially true for patients with hypertension or diabetes, those with high fats or lipids in the blood, and those who smoke
The most common cause of peripheral vascular disease is peripheral artery disease.
- Peripheral artery disease is due to atherosclerosis. This is a gradual process in which a fatty material builds up inside the arteries.
- The fatty material mixes with calcium, scar tissues, and other substances and hardens slightly, forming plaques of arteriosclerosis.
- These plaques block, narrow, or weaken the vessel walls.
- Blood flow through the arteries can be restricted or blocked totally.
Other causes of peripheral vascular disease include the following:
- Blood clot: A blood clot can block a blood vessel (thrombus/emboli).
- Diabetes: Over the long term, the high blood sugar level of persons with diabetes can damage blood vessels. This makes the blood vessels more likely to become narrowed or weakened. Plus, people with diabetes frequently also have high blood pressure and high fats in the blood, which accelerates the development of atherosclerosis.
- Inflammation of the arteries: This condition is called arteritis and can cause narrowing or weakening of the arteries. Several autoimmune conditions can develop vasculitis, and, besides the arteries, other organ systems are also affected.
- Infection: The inflammation and scarring caused by infection can block, narrow, or weaken blood vessels. Both salmonellosis (infection with Salmonella bacteria) and syphilis have been two infections traditionally known to infect and damage blood vessels.
- Structural defects: Defects in the structure of a blood vessel can cause narrowing. Most of these cases are acquired at birth, and the cause remains unknown. Takayasu disease is a vascular disease affecting the upper vessels of the body and affects usually Asian females.
- Injury: Blood vessels can be injured in an accident such as a car wreck or a bad fall.
Risk factors for peripheral vascular disease (and atherosclerotic disease of all arteries throughout the body)
- Positive family history of premature heart attacks or strokes
- Older than 50 years
- Overweight or obesity
- Inactive (sedentary) lifestyle
- High blood pressure
- High cholesterol or LDL (the "bad cholesterol"), plus high triglycerides and low HDL (the "good cholesterol")
People who have coronary heart disease or a history of heart attack or stroke generally also have an increased frequency of having peripheral vascular disease.
Only about half of the individuals with peripheral vascular disease have symptoms. Almost always, symptoms are caused by the leg muscles not getting enough blood. Whether you have symptoms depends partly on which artery is affected and to what extent blood flow is restricted.
The most common symptom of peripheral vascular disease in the legs is pain in one or both calves, thighs, or hips.
- The pain usually occurs while you are walking or climbing stairs and stops when you rest. This is because the muscles' demand for blood increases during walking and other exercise. The narrowed or blocked arteries cannot supply more blood, so the muscles are deprived of oxygen and other nutrients.
- This pain is called intermittent (comes and goes) claudication.
- It is usually a dull, cramping pain. It may also feel like a heaviness, tightness, or tiredness in the muscles of the legs.
- Cramps in the legs have several causes, but cramps that start with exercise and stop with rest most likely are due to intermittent claudication. When the blood vessels in the legs are completely blocked, leg pain at night is very typical, and the individual almost always hangs his or her feet down to ease the pain. Hanging the legs down allows for blood to passively flow into the distal part of the legs.
Other symptoms of peripheral vascular disease include the following:
- Buttock pain
- Numbness, tingling, or weakness in the legs
- Burning or aching pain in the feet or toes while resting
- A sore on a leg or a foot that will not heal
- One or both legs or feet feel cold or change color (pale, bluish, dark reddish)
- Loss of hair on the legs
Having symptoms while at rest is a sign of more severe disease.
When to Seek Medical Care
When you have symptoms of peripheral vascular disease in a leg or a foot (or in an arm or a hand), see your health care provider for an evaluation.
Generally, peripheral vascular disease is not an emergency. On the other hand, it should not be ignored.
- Medical evaluation of your symptoms and effective treatment, if indicated, may prevent further damage to your heart and blood vessels.
- It may prevent more drastic events such as a heart attack or stroke or loss of toes and feet.
If you have symptoms of peripheral vascular disease along with any of the following, go to the nearest hospital emergency department.
- Pain in the chest, upper back, neck, jaw, or shoulder
- Fainting or loss of consciousness
- Sudden numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body
- Sudden confusion, trouble speaking or understanding
- Sudden trouble seeing in one or both eyes
- Sudden dizziness, difficulty walking, loss of balance or coordination
- Sudden severe headache with no known cause
Do not try to "wait it out" at home. Do not try to drive yourself. Call 911 right away for emergency medical transport.
The best way to prevent peripheral vascular disease is to reduce your risk factors. You cannot do anything about some of the risk factors, such as age and family history. Other risk factors are under your control.
- Do not smoke.
- Eat nutritious, low-fat foods; avoid foods high in cholesterol.
- Maintain a healthy weight.
- Engage in moderately strenuous physical activity for at least 30 minutes a day. At least walk briskly for 20-30 minutes daily.
- Control high blood pressure.
- Lower high cholesterol (especially LDL cholesterol or the "bad cholesterol") and high triglyceride levels, and raise HDL or "the good cholesterol." If exercise fails to lower your cholesterol, certain medications (statin drugs) can be taken to decrease the bad cholesterol.
- If you have diabetes, control your blood sugar level and take scrupulous care of your feet. Ask your doctor what your HbA1C is, a measure of how well your blood sugar is controlled; it should be less than 7.0. If it is greater than 8.0, it is not controlled, and your risk of blood vessel complications (eyes, heart, brain, kidneys, legs) escalates.
Smoking is a very strong risk factor for developing peripheral vascular disease and can significantly worsen the disease, especially in diabetics. Quitting smoking can reduce the symptoms of peripheral vascular disease and lower your chance that the disease will get worse.
If untreated, peripheral vascular disease can develop complications:
- Permanent numbness, tingling, or weakness in legs or feet
- Permanent burning or aching pain in legs or feet
- Gangrene: This is a very serious condition. It is the result of a leg or foot or other body part not getting enough blood. The tissues die and begin to decay. The only treatment is amputation of the affected body part.
People with peripheral vascular disease are at higher-than-normal risk of heart attack and stroke.