THE CARDIOVASCULAR INSTITUTE

PERIPHERAL VASCULAR DISEASE

Peripheral vascular disease (PVD) refers to obstructions or blockages in the arteries or veins outside of your central circulation. It can arise in your arms, legs, the carotid arteries in your neck leading to your brain, or arteries leading to your kidneys. However, in most cases, such blockages are in the arteries and are called peripheral arterial disease (PAD).

WHAT ARE THE SYMPTOMS OF PAD?

In the legs, the key symptom is cramping discomfort that occurs in the calf or thigh when you walk and goes away quickly when you stop. This is called intermittent claudication. In the carotid artery, PAD may cause transient ischemic attacks (TIAs), also called mini-strokes. You may feel a slight weakness on one side or blurriness in one eye that passes within minutes. In the arm, it may cause pain during exercise and affect circulation to the balance centers of the brain. But 9 out of 10 people with PAD do not have symptoms -- and don't know about the problem until a crisis occurs.

WHY IS PAD HAZARDOUS?

Blockages in leg arteries can be a critical harbinger for crises such as heart attack, stroke, and kidney failure. About 50% of people with blockages in their peripheral arteries also have heart disease. Development of blockages in the arteries leading to the kidneys can cause high blood pressure, kidney failure, or heart failure.

HOW IS PAD DETECTED?

Simple blood pressure screening may provide a clue, for example, if blood pressure is much lower in your left arm than your right or much lower in one or both legs than in your arms. If problems are found, it will likely prompt testing and evaluation for blockages in other parts of the body. Further non-invasive studies may include Doppler, ultrasound, and MRI, depending on the location of the possible blockage.

HOW IS PAD TREATED?

Peripheral arterial disease is treated in many of the same ways doctors treat blocked arteries in the heart. They may start with medications, such as anti-platelet agents, vasodilators, and lipid-lowering drugs. Depending on symptoms, test results, and the location of the blockage, your doctor may recommend more aggressive therapy. One choice is angioplasty that reopens blocked arteries through the use of an inflated balloon that compresses the atherosclerotic plaque in the wall of the artery. If necessary, stents can be placed in the blockages and narrowings of the leg and renal arteries to prop them open. Through an FDA-approved study, stents are now placed in the carotid arteries and show promising results. The surgical option is endarterectomy where the atherosclerotic plaque is removed through a surgical incision.

PVD OF THE VEINS

PVD involving the veins is less common. The most well known is varicose veins -- veins that have incompetent valves, permitting reversed blood flow. The cause is unknown but is associated with family history. Aching, fatigue and heat in the legs is relieved by raising them or wearing compression stockings. For more severe varicosities, injection therapy can seal up the offending veins or they may be surgically removed.

Venous Thrombosis is the presence of a blood clot in a vein, most often the calf. It can lead to edema, pain, rashes, and ulceration. It may arise from injury to the vein, oral contraceptive use, prolonged bed rest, or unknown causes. Because such clots can break off, travel through the body, and lodge in the lung or a coronary artery, any symptoms warrant immediate medical consultation. Blood thinning medications are often prescribed as treatment.