The term peripheral vascular disease or peripheral arterial disease (PVD), meaning an occlusion or narrowing by atherosclerotic plaques of the arteries, not in the heart or brain. This means that the blood circulation through the arteries (large blood vessels that carry the blood from the heart) is decreased. This causes symptoms, most notably tight, aching, or squeezing pain in your calf, thigh, or buttock. This pain, called intermittent claudication, usually happens after you have walked a certain distance.
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. PAD or PVD typically causes pain and fatigue, often in your legs, and especially during exercise. The pain usually improves with rest.
There are two ways atherosclerosis causes disease;
The first noticeable symptom of PAD may be intermittent claudication. This is leg discomfort, pain or cramping that develops with activity, is relieved with rest, and recurs upon resuming activity. The pain is most often noticed in the calf, but may also be felt in the buttocks or thighs.
About 5% of people over the age of 50 are believed to suffer from peripheral artery disease. This translates into about 10 million adults affected in the U.S. Peripheral artery disease affects men and women over the age of 50, with men having a slightly higher risk. Peripheral artery disease affects one in three diabetics over the age of 50. In the US, it affects 12–20 percent of Americans age 65 and older. Despite its prevalence and cardiovascular risk implications, only 25% of PAD patients are undergoing treatment. The risk factors are associated with the same risk factors for development of atherosclerosis and coronary artery disease.
Risk factors for peripheral artery disease include;
With peripheral artery disease, the risk factor is additive, meaning that a person with two risk factors – diabetes and smoking, for instance – has an increased chance of developing a severe case of peripheral artery disease that a person that only has one risk factor. Smokers are 23 times more likely to have lower extremity PAD than coronary artery disease. But, according to researchers at Cleveland Clinic, smoking is the single most important modifiable (changeable) risk factor for PAD and its complications. Smoking increases the risk for PAD by 400 percent and brings on PAD symptoms almost 10 years earlier.
The best way to see if you might have PAD is to get a complete checkup with your doctor. During a physical exam the doctor may look for signs of vascular disease and PAD, which might include a change in blood pressure in the limbs at rest and/or during a treadmill test, weak or absent artery pulse in the extremities, and skin color and nail changes. A vascular surgeon will also perform a physical exam. Your doctor may order certain tests to help diagnose PAD and determine the severity of the peripheral vascular disease.
The American College of Cardiology Foundation and the American Heart Foundation (ACCF/AHA) collaborated to create the "2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline)." They published the document in the journal Download -
They recommend the following lifestyle changes:
• Regular physical activity – Your doctor will recommend an effective treatment of supervised exercise training. The patient may have to start slowly and progress to a goal set by your doctor. Decreased symptoms of vascular disease can be achieved in just 4-8 weeks by following a simple regimen three times a week of walking, leg exercises, and a treadmill program. Walking might be painful starting out as intermittent claudication (pain in calves and thighs) may call for a program of alternating between activity and resting
• Diet changes and adjustments – If you are an individual with PAD, you may also have elevated cholesterol levels. A diet low in saturated fat, trans fat, and cholesterol, as well as plenty of fruit and vegetables, can help lower blood cholesterol levels.
• Smoking cessation - Quitting smoking reduces symptoms and lowers your chance of having your peripheral artery disease (and arteries elsewhere) get worse.
• Some medications - the doctor may prescribe antihypertensive drugs as well as statins to lower cholesterol levels.
PAD may be treated in the San Antonio Regional Hospital Cath Lab by interventional cardiologists. Balloon angioplasty, also known as percutaneous transluminal angioplasty, or PTA, is a nonsurgical procedure that can widen a narrowed or blocked artery. Using imaging for guidance, the cardiologists thread a catheter through the femoral artery in the groin, to the blocked artery in the legs. Then a balloon is inflated to open the blood vessel where it is narrowed or blocked. In some cases, this is then held open with a stent, (a cylindrical wire mesh tube). Angioplasty does not require general anesthesia. Usually, a local anesthetic at the area of catheter insertion and a mild sedative is given.
Complications from undiagnosed and untreated vascular disease can be serious and even life-threatening. Restricted blood flow of PAD can be a warning sign of other forms of vascular disease.
Complications of PAD can include:
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.
Addressing the following risk factors can help prevent or delay PAD:
• Smoking - smoking is more closely related to developing heart disease than any other risk factor. Regular smokers are four times as likely to develop PAD than lifetime non-smokers. Talk to a doctor about programs and products that can help you quit smoking.
• Diet - follow a healthy eating plan that is low in total fat, saturated fat, trans fat, cholesterol, and sodium. Eat plenty of fruits, vegetables, and low-fat dairy products. Overweight and obese patients should work with a doctor to create a reasonable weight-loss plan. If you have diabetes, controlling high blood sugar can prevent damage to blood vessels.
• Exercise - Regular exercise, such as walking, can reduce symptoms and increase the distance you can walk without symptoms.
• Maintain a healthy weight.
• Follow your health-care professional's recommendations for controlling high blood pressure and high cholesterol.
PAD may be treated in the San Antonio Regional Hospital Cath Lab by interventional cardiologists. Using imaging for guidance, the cardiologists thread a catheter through the femoral artery in the groin, to the blocked artery in the legs. Then a balloon is inflated to open the blood vessel where it is narrowed or blocked. In some cases, this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a small opening in the skin about the size of a pencil tip.
Balloon angioplasty and
stenting have generally replaced invasive surgery as the first-line treatment for PAD. Studies have shown interventional therapy for PAD to be as effective as surgery for many arterial occlusions.
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