Peripheral Vascular Disease -- July 21, 2008 -- Dr. Paul Fleser - NewsChannel5.com | Nashville News, Weather & Sports

Peripheral Vascular Disease

Peripheral vascular disease occurs when plaque builds up on the inside walls of the arteries that carry blood from the heart to the head, internal organs and limbs. PVD most commonly affects blood flow to the legs.

The buildup of plaque on the artery walls is called atherosclerosis, or hardening of the arteries. Atherosclerosis causes the arteries to narrow or become blocked, which can reduce or block blood flow.

Blocked blood flow can cause pain and numbness. It also can increase a person's chance of getting an infection, and it can make it difficult for the person's body to fight the infection. A person with PVD is at increased risk of having a heart attack or stroke. Early diagnosis and treatment of the disease are important to prevent disability and save lives.

Peripheral vascular disease affects 8 to 12 million people in the United States. An estimated 5 percent of U.S. adults over age 50 have PVD. Among adults age 65 and older, 12 to 20 percent may have PVD.

Risk factors include:

• Smoking. Smoking is more closely related to developing PVD than any other risk factor. Smokers are three to five times more likely than nonsmokers to develop the disease. On average, smokers who develop PVD experience symptoms 10 years earlier than nonsmokers who develop PVD. Smokers and diabetics have the greatest risk of complications, including gangrene in the leg from decreased blood flow.
• Chronic or serious illnesses, such as diabetes. One in three people over age 50 with diabetes is likely to have PVD. Anyone over age 50 with diabetes should be screened for the disease.
• Other diseases and conditions, such as:
• Kidney disease
• High blood pressure or a family history of it
• A high cholesterol level or a family history of it
• Heart disease or a family history of it
• A family history of stroke
• Age. Men who are older than age 50 and women who are older than age 55 are at higher risk for PVD.

Symptoms

At least half of the people who have peripheral vascular disease don't have any signs or symptoms of the disease. People who do have signs or symptoms may have pain when walking or climbing stairs, which may be relieved after resting.

Other signs and symptoms of PVD include:

• Pain, numbness, aching and heaviness in the muscles
• Cramping in the legs, thighs, calves and feet
• A weak or absent pulse in the legs or feet
• Sores or wounds on toes, feet or legs that heal slowly, poorly, or not at all
• Color changes in skin, paleness or blueness
• A decreased temperature in one leg compared to the other leg
• Poor nail growth and decreased hair growth on toes and legs

Treatment

The overall goals for treating peripheral vascular disease are to reduce symptoms, improve quality of life and prevent complications. Treatment is based on symptoms, risk factors, physical exam results and diagnostic tests. Specific treatments for PVD include lifestyle changes, medicines and surgery or special procedures.

Treatment often includes making long-lasting lifestyle changes, such as:

• Quitting smoking
• Lowering blood pressure
• Lowering high cholesterol levels
• Lowering blood glucose levels if you have diabetes
• Following a low-saturated fat, low-cholesterol diet, and eating foods with less salt, total fat and saturated fat

Medicines may be prescribed to:

• Lower high cholesterol levels and high blood pressure
• Thin the blood to prevent clots from forming due to low blood flow
• Dissolve blood clots
• Help improve pain in the legs that is the result of walking or climbing stairs

Blood thinners may be prescribed to prevent clots in the arteries. Thrombolytic therapy involves clot-dissolving drugs inserted into an artery to break up a blood clot.

Surgeries or Special Procedures

Surgery may be necessary if blood flow in a limb is completely or almost completely blocked. In bypass grafting surgery, the doctor uses a blood vessel from another part of your body or a tube made of synthetic material to make a graft. This graft bypasses the blockage in the artery, allowing blood to flow around it. Surgery does not cure PVD, but it may increase blood flow to the limb.

Angioplasty may be performed to restore blood flow through a narrowed or blocked artery. During the procedure, a small catheter is inserted into a blocked artery and a small balloon on the tip of the catheter is inflated. When the balloon is inflated, plaque is pushed against the artery walls. This causes the artery to widen, restoring blood flow. A stent, a tiny mesh tube that looks like a small spring, is now used in most angioplasties. Some stents are coated with medicine to help prevent the artery from closing again.

Plaque excision allows blockages to be removed altogether, restoring blood flow to the legs, feet and toes. Plaque excision is normally performed through a small puncture site in the leg. A tiny, rotating blade shaves away plaque from inside the artery. As it is excised, the plaque collects in the tip of the device and then is removed from the patient.