Peripheral vascular disease (PVD), or peripheral artery disease (PAD), is vascular disorder characterized by a narrowing of the arteries that carry blood to the leg and arm muscles. This disease reduces blood flow, especially to the legs and feet, making walking painful and difficult. It can also cause insufficiency in the veins carrying blood back to the heart, creating pooling of blood in the lower extremities with heaviness and pain. The most common cause of PVD is atherosclerosis (the buildup of plaque in the artery wall). PVD is a slow and progressive circulation disorder.
Other vascular conditions associated with PVD include:
- Deep vein thrombosis (DVT): A thrombus or clot forms in a deep vein, and has the potential to dislodge, travel to the lungs, and cause a potentially life-threatening event.
- Varicose veins: These dilated, twisted veins are caused by incompetent valves (valves that allow backward flow of blood) allowing blood to pool. It is most commonly found in the legs or lower trunk. Symptoms include bruising and sensations of burning or aching and chronic venous insufficiency.
- Buerger's disease (thromboangiitis obliterans): This chronic inflammatory disease in the peripheral arteries of the extremities leads to the development of clots in the small- and medium-sized arteries of the arms or legs and eventual blockage of the arteries.
- Raynaud's phenomenon: In this condition, the smallest arteries that bring blood to the fingers or toes constrict (go into spasm) when exposed to cold or as the result of emotional upset.
- Lymphedema: This peripheral vascular disease causes swelling in the arms or legs because of blockage in the lymphatic vessels.
- Thrombophlebitis: Most commonly occurring in the legs, a blood clot in an inflamed vein causes red streaks in the area and danger of the clot traveling.
After inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye to make the arteries and veins visible, an x-ray of your arteries and veins can detect blockage or narrowing of the vessels.
Ankle-Brachial Index (ABI)
This test compares the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device.
Blood Lipid Profile
This blood test measures the levels of each type of fat in your blood: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and others.
Doppler Ultrasound Flow Studies
Doppler uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs to measure and assess the flow of blood.
Magnetic Resonance Angiography (MRA)
This noninvasive diagnostic procedure uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within your body, to assess blood flow.
Treadmill Exercise Test
This test is given while you walk on a treadmill to monitor your heart during exercise.
Comparable to the ankle brachial index, this test uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements compared to the systolic blood pressure in the arm.
Pulse Volume Recording (PVR) Waveform Analysis
This technique calculates blood volume changes in the legs using a recording device that displays the results as a waveform.
Reactive Hyperemia Test
Similar to an ABI or a treadmill test, this procedure is used for people who are unable to walk on a treadmill. While you are lying on your back, comparative blood pressure measurements are taken on your thighs and ankles to determine any decrease between the two sites.
Segmental Blood Pressure Measurements
This measurement compares blood pressure measurements in different areas using a Doppler device on the upper thigh, above and below the knee, at the ankle, and on the arm to determine any constriction in blood flow.
This is the most commonly performed diagnostic test for DVT and involves using high frequency sound waves to look at the speed of blood flowand the veins. Occasionally a blood clot may be visualized by ultrasound. This procedure is noninvasive (the skin is not broken) and involves placing ultrasound gel on the affected area and then moving a handheld device across it. A picture of the blood flow is displayed on a monitor.
Magnetic Resonance Imaging (MRI)
This diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body is particularly effective in diagnosing deep vein thrombosis in the pelvis.
Using X-rays and intravenous (IV) contrast dye to visualize the veins allows the physician to visualize the blood vessels being evaluated
Color-Flow Imaging (Triplex Ultrasound)
This procedure is similar to the duplex ultrasound that uses color to highlight the direction of blood flow.
Magnetic Resonance Venography (MRV)
This diagnostic procedure uses magnetic resonance technology and intravenous (IV) contrast dye to visualize the veins. MRV is useful in some cases because it can help detect causes of leg pain other than vein problems.
PVD and atherosclerosis
- Controlling risk factors, including regular exercise, proper nutrition, and smoking cessation are important for maintaining circulation.
- Aggressive treatment of existing conditions that may aggravate PVD, such as management of diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol) are critical to long-term health.
- Different drugs such as blood thinners can help to improve blood flow, and medications that relax the blood vessel walls can be helpful.
- In an angioplasty, a long hollow tube can be inserted into the vessel to create a larger opening and increase blood flow. Different types of angioplasty may be performed.
- During a balloon angioplasty, a small balloon is inflated inside the blocked artery to open the blocked area and is then removed.
- Atherectomy, the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter.
- Laser angioplasties use a laser to "vaporize" the blockage in the artery.
- Finally, a stent is a tiny coil which is expanded inside the blocked artery to open the blocked area and keep the artery open.
- Vascular surgery involves a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material being placed in the area of the blocked or narrowed artery to reroute the blood flow
- The most common treatment for both spider and varicose veins, is sclerotherapy. This procedure involves a saline or chemical solution that is injected into the varicose veins so they harden and no longer fill with blood. The veins that received the injection will eventually shrivel and disappear. The scar tissue is absorbed by the body
- Laser treatment can also be used to treat varicose veins. There are several types of lasers that may be used. A laser fiber inserted into a varicose vein through a catheter sends out laser energy that destroys the diseased portion of your varicose vein so your body can absorb it.
- Finally, during Ablation, a thin, flexible catheter inserted into a varicose vein heats the walls of the veinand destroys the vein tissue so it can be absorbed.
Deep Vein Thrombosis (DVT)
- Anticoagulants or blood thinners, can keep the clot from growing and prevent others from forming. Treatment with blood thinners may last from three to six months. If a blood clot develops after surgery, treatment may be shorter. If there have been previous clots or treatment for another illness is underway, the treatment may last as long as risk factors are present.
- "Clot busters" such as Fibrinolytics or thrombolytics can dissolve a clot quickly, over a period of a few days and may be used in certain situations as determined by a physician.
- Thrombin inhibitors can disrupt the formation of a clot. Patients who cannot take heparin may be given one of these medications.
- In some cases, a vena cava filter may be inserted into the large vein which returns blood from the body to the heart if you cannot take medication or if blood thinners are not working. The filter is a kind of "clot catcher."
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