Peripheral Vascular Disease & Treatment

Peripheral Vascular Disease commonly called Peripheral Arterial Disease refers to obstruction of large arteries except those supplying the heart, head, neck or brain. The basic abnormality is either a narrowing of the peripheral arteries as a result of any inflammatory process involving the vessels or there is a mechanical obstruction to the flow of blood distal to the site of obstruction. This may include Atherosclerosis, a condition in which an arterial wall thickens due to accumulations of fatty materials such as cholesterol, or it may be blockage of the artery by a blood clot called a thrombus or an embolus which is any intravascular mass detached from its origin and is capable of blocking an artery at a distant site.

Peripheral vascular disease is a term used commonly for the atherosclerotic blockage of arteries found in the lower extremities. There are a series of symptoms, progressive as the disease advances leading to a disabling condition that is amputations usually if not intervened at a proper time. It starts as a mild pain while walking known as claudicating caused by incomplete blood vessel obstruction. This stage leads to a more severe pain while walking at a relatively shorter distance known as intermittent claudicating. This is followed by pain even at rest which increases when the limb is raised. The worst and rather irreversible stage is the stage of biological tissue loss and gangrene. Other associated symptoms are sores, wounds and ulcers of the affected area that are usually poor in healing or do not heal at all. Some noticeable colour changes means the affected part turns pale and colder than the normal part and diminished hair and nail growth can be noticed.

The risk factors include:

1. Smoking, the single most important modifiable cause of peripheral vascular disease internationally. Smokers have a tenfold increase in relative risk for the disease.

2. Diabetes mellitis causes 2-4 times increase risk of the disease. This group accounts for approximately up to 70% of the non traumatic amputations performed. A known diabetic who smokes increases his risk of getting the vascular insufficiency.

3. Dyslipidemias including elevated cholesterol levels, high bad cholesterols known as LDL, low good cholesterols, HDL, elevated triglyceride levels are also co related with PVD (peripheral vascular disease)

4. High blood pressures are associated with increased risk of PVD as well as with heart attacks and strokes.

Some of the tests the doctor may rely to diagnose are:

(a) Physical examination:
Might reveal signs such as weak or absent pulses in the affected limb, whooshing sounds known as bruits can be heard with a stethoscope, evidence of poor wound healing and decreased blood pressure in the affected limb

(b) Ankle Brachial Pressure Index:
It is a common test to diagnose PVD. It compares the blood pressure in the ankle to the blood pressure in the arm. If the blood pressure reading in the ankle is lower than that in the arm, blockage of the arteries providing blood from the heart to distal lower limb is suspected.

(c) Ultrasound:
Special ultrasound imaging techniques, such as Doppler ultrasound helps to look for site and extent of blockage or narrowing of arteries.

(d) Angiography:
Modern diagnostic imaging techniques such as magnetic resonance angiography (MRA) or computed tomography angiography (CTA) allows the imaging of the arterial system following the injection of a dye in the blood vessels. Some more invasive procedures for example catheter angiography allows diagnosis as well as treatment at the same time which involves passage of a catheter from an artery in the groin of the patient to the affected narrowed part of the artery and widening that part with angioplasty procedure or injecting some medicine to improve the blood flow in that part

(e) Blood tests: for diabetes and cholesterol levels

The treatment aims at:

(a) Relieving symptoms such as leg pain etc

(b) To stop the progression of atherosclerosis throughout the body to reduce risk of heart attacks and stroke. The first step in achieving these goals is to change one’s lifestyle. Quieting smoking is the single most important thing to reduce the risk of complications. Management of diabetes, management of high blood cholesterol levels and high blood pressures all contribute to reduce the rate of disease progression and to avoid the complications. If medical treatment alone is insufficient surgical intervention may be required in the form of angioplasty or bypass surgery. Moreover supervised exercise programs can help to increase the distance a patient can walk pain free.

Critical limb ischemia is a serious complication that begins as open sores that don’t heal an injury or an infection of the feet or legs and they progress to tissue death and gangrene sometimes requiring amputations of the affected limb. Heart attack and stroke are other complications if the fat deposits also build in arteries supplying the heart and brain respectively.