Peripheral Vascular Disease
Peripheral Vascular Disease |
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Peripheral vascular disease (PVD) is a catch-all term for various problems caused by poor circulation due to clogged arteries. PVD is most common in men over the age of 50, and primarily refers to the effects of poor circulation in the legs and arms. Plaque is a kind of sludge made up of hardened fat, cholesterol, white blood cells, calcium, decaying tissue, and other cellular "garbage." Over time, wear and tear inside the blood vessel walls create rough spots on which plaque can "catch" and build up, eventually blocking blood flow through those vessels. This condition is called atherosclerosis, or "hardening of the arteries."
The arteries carry oxygen- and nutrient-rich blood to all the body¹s tissues and organs. When blood flow is reduced due to narrowed arteries, the muscles do not get enough oxygen and nutrients when they need it most‹during exercise, such as walking. This "starvation" of the muscles causes the hallmark symptom of PVD‹intermittent claudication. This is a cramping pain that strikes during exercise and subsides with rest. The location of the pain is the area that isn¹t getting enough circulation, such as the calves, buttocks, feet, hips, or thighs. If left untreated, PVD can worsen, causing open sores on the legs and gangrene (tissue death).
The most common cause of PVD is atherosclerosis. Other possible causes include:
1. Buerger¹s disease, a severe inflammation of arteries in the legs
2.Raynaud¹s disease, a constriction of the arteries, usually affecting the fingers
3. deep vein thrombosis (clot formation)
4. varicose veins
5. diabetes mellitus Factors that can put a person "at risk" for developing PVD are:
6. being a man over age 50
7. cigarette smoking
8. high blood pressure
9. high cholesterol levels
10. heart disease
The location of the blockage determines the symptoms. PVD symptoms caused by poor blood flow through the arteries that supply the legs include:
1. intermittent claudication, with pain worsening with exercise, exposure to cold, and the use of any drugs that constrict blood vessels and/or reduce blood flow
2. cold legs and feet
3. paleness of legs and feet when elevated
4. blue/red discoloration of the feet or toes
5. fragile, shiny, scaly, or hairless skin
6. numbness, tingling, or pain in the legs, calves, feet, toes, buttocks, or thighs
7. sores on the legs that do not heal
8. gangrene
9. impotence
PVD symptoms caused by poor blood flow through the arteries that supply the brain include:
1. sudden, temporary weakness or numbness of the face, arm, and/or leg on one side of the body
2. temporary loss of speech or trouble speaking or understanding speech
3. temporary decline or loss of vision, particularly in one eye
4. unexplained dizziness or unsteadiness
PVD symptoms caused by poor blood flow through the arteries that supply the kidneys include:
1. high blood pressure (consistently over 140/90)
2. inability of the kidneys to filter out waste products and balance salt and fluid levels
To diagnose PVD, the doctor will take a thorough medical history, do a physical examination, and request various laboratory and other diagnostic tests. During the physical exam, the doctor will feel the pulsations of the arteries in key locations, including the back of the knee, the top of the foot, and just behind the bone on the inside of the ankle. The doctor might also wrap a blood pressure cuff around each arm and leg and measure the blood pressure of each. The diagnostic tests might include an ultrasound or magnetic resonance imaging (MRI) for a detailed view of the inside of the arteries. Another diagnostic option is plethysmography, a technique that measures blood flow in the leg veins. With electrodes applied to the leg, the plethysmograph records changes in electrical resistance caused by changes in blood flow variations. The doctor might also request an arteriogram, an x-ray taken of arteries after a contrast dye is injected to help show areas of atherosclerosis and structural changes clearly.
Treatment of PVD begins with the following lifestyle changes:
1. quitting smoking
2. walking each day until leg pain develops, then resting and continuing until pain develops again, with the goal of traveling ever-increasing distances without pain
3. maintaining a weight appropriate for height, frame, age, and gender
4. adhering to a healthful, balanced diet low in fat, salt, and cholesterol, and including vegetables, fruits, grains, dried beans, poultry, fish, and low-fat meats and dairy products
5. practicing good foot hygiene by washing the feet every day and immediately applying moisturizing lotion; tucking cotton or lamb's wool between the toes if the skin is starting to crack; wearing comfortable, "breathable" shoes that protect the feet; avoiding footwear made of plastic or other synthetic materials; wearing cotton socks; and avoiding garters, support stockings, and socks with elastic tops because they can impede blood flow
6. keeping blood pressure under control
1. pentoxifylline (Trental) to thin the blood and improve its flow
2. drugs that lower blood pressure by various mechanisms
3. calcium-channel blockers, which relax blood vessel walls
4. aspirin to thin the blood and thus prevent clots
1. bypass surgery to reroute blood flow around the obstruction
2. balloon angioplasty, in which a small balloon on the end of a thin tube is inserted in the artery, guided to the blockage, and then inflated to compress plaque against the artery wall and open up the artery
3. stent placement, inserting and leaving a small metal tube in place to prop open an artery
4. amputation (removal of a body part) to eliminate gangrenous tissue permanently
The following measures might help prevent PVD:
1. quitting smoking
2. exercising regularly
3. maintaining a weight appropriate for height, frame, age, and gender
4. eating foods low in saturated fat, salt, and cholesterol
Peripheral Vascular Disease |
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