Peripheral Vascular Disease

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Introduction

What is peripheral vascular disease?

Peripheral vascular disease is a condition in which the blood vessels in the lower extremities (feet, legs, or thighs) are narrowed, restricting blood flow. Peripheral vascular disease is primarily caused by atherosclerosis, the buildup of plaque in blood vessels.

Individuals with diabetes, high blood pressure, high cholesterol, or advanced age, or those who smoke or are inactive, are at risk for developing peripheral vascular disease. Approximately eight to 12 million people in the United States have peripheral vascular disease (Source: NHLBI).

Often, lifestyle modifications, including a healthy diet and regular exercise, can successfully treat peripheral vascular disease. Depending on the severity and underlying cause, your health care provider may also recommend medications or minimally invasive procedures to manage your symptoms and stop the progression of atherosclerosis.

Although life-threatening complications of peripheral vascular disease are rare, individuals with peripheral arterial disease due to atherosclerosis may also be at risk for heart attack or stroke. Seek immediate medical care (call 911) if you experience shortness of breath, pain or pressure in the chest area, severe or sudden headache, or difficulty walking, or if you think you may be having a heart attack or stroke.

Seek prompt medical care if you are being treated for peripheral vascular disease but have mild symptoms that recur or are persistent.

Symptoms

What are the symptoms of peripheral vascular disease?

Individuals with mild peripheral vascular disease may experience no symptoms. Those with moderate or severe blood vessel blockages often experience symptoms that are the result of restricted blood flow to the lower extremities.

Intermittent claudication

One of the most common symptoms of peripheral vascular disease is intermittent claudication. Intermittent claudication is the medical term for pain, numbness, achiness, burning, heaviness or cramping in the lower limbs that occurs during activities such as walking or climbing stairs. The symptoms may be felt in any of the lower limb muscles, including those in the feet, calves, thighs or buttocks. This symptom usually decreases after the activity is stopped and the muscles rest.

Other common symptoms of peripheral vascular disease

In addition to intermittent claudication, you may experience peripheral vascular disease symptoms daily or just once in a while. At times, any of these symptoms can be severe:

  • Burning or tingling sensation (paresthesia)

  • Cold feet or legs

  • Decreased or absent pulse in the lower limbs

  • Erectile dysfunction

  • Pale or bluish skin

  • Poor hair growth on the legs

  • Poor toenail growth

  • Resting leg pain (especially when supine)

  • Sores or wounds on the lower limbs that heal slowly, poorly, or not at all

Serious symptoms that might indicate a life-threatening condition

Individuals with peripheral vascular disease are at risk for stoke or heart attack due to atherosclerosis. Stroke and heart attacks can be life threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms of stroke or heart attack including:

  • Blurred or double vision

  • Chest pain or pressure

  • Difficulty walking

  • Difficulty with memory, thinking, talking, comprehension, writing or reading

  • Lightheadedness

  • Nausea with or without vomiting

  • Pain in the back, neck, jaw or stomach

  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking

  • Severe or sudden headache

  • Sudden paralysis or muscle weakness

  • Sweating

Causes

What causes peripheral vascular disease?

The primary cause of peripheral vascular disease is atherosclerosis. Atherosclerosis is the buildup of plaque (consisting mostly of fat and cholesterol) in blood vessels.

Atherosclerosis is initiated by damage to blood vessels from smoking, high amounts of certain fats and cholesterol in the blood, high blood pressure, and high amounts of sugar in the blood due to insulin resistance or diabetes. Plaque adheres to the blood vessel walls where the damage occurred. Platelets (small blood fragments) may stick to the plaque and form blood clots. Both plaque and blood clots can narrow the blood vessels, restricting blood flow.

What are the risk factors for peripheral vascular disease?

A number of factors increase the risk of developing peripheral vascular disease. Not all people with risk factors will get peripheral vascular disease. Risk factors for peripheral vascular disease include:

  • Advanced age

  • Diabetes (chronic disease that affects your body’s ability to use sugar for energy)

  • High-risk behaviors and lifestyle choices, such as being sedentary or eating a diet that is high in saturated fat, trans fat, and cholesterol

  • Hyperhomocysteinemia

  • Overweight or obesity

  • Personal or family history of high blood pressure

  • Personal or family history of high cholesterol

  • Personal or family history of stroke or heart disease

  • Smoking

Reducing your risk of peripheral vascular disease

You may be able to lower your risk of peripheral vascular disease by:

  • Eating a diet that is low in saturated fat, trans fat, and cholesterol

  • Participating in a regular exercise program

  • Quitting smoking

Treatments

How is peripheral vascular disease treated?

Treatment of peripheral vascular disease has two main aims. The first aim is to manage symptoms so that you can return to your normal activity level. The second aim of treatment is to limit or completely stop the progression of atherosclerosis.

Often, lifestyle modifications, including a healthy diet and regular exercise, can successfully treat peripheral vascular disease. Depending on the severity and underlying cause, your health care provider may also recommend medications or minimally invasive procedures.

What you can do to improve your peripheral vascular disease

In most cases, lifestyle modifications can be the most effective treatment for peripheral vascular disease. Your health care provider may recommend:

  • Eating a diet low in saturated fat, trans fat, and cholesterol

  • Quitting smoking

  • Starting a supervised exercise program

Medications used to treat peripheral vascular disease

Depending upon your individual situation and risk factors, your health care provider may prescribe medicines from a number of different classes including:

  • Antihyperglycemic drugs, which control blood sugar in diabetes

  • Antihypertensive medications, which lower blood pressure

  • Antiplatelet drugs, which limit blood clot formation

  • Pain medications, which reduce pain during activity

  • Statins and other drugs, which lower blood cholesterol levels

Procedures used to treat peripheral vascular disease

If blood flow is completely or almost completely blocked, your health care provider may recommend one of the following procedures:

  • Angioplasty, in which the blocked blood vessel is widened by inflating a balloon-like catheter inside the blood vessel. A small mesh tube called a stent may be placed in the vessel to keep it open.

  • Bypass grafting, in which the blocked blood vessel is bypassed with a blood vessel harvested from another part of your body or with manufactured tubing

  • Thrombolytic therapy, in which a clot-dissolving drug is injected into the blood vessel to break up blood clots

What are the potential complications of peripheral vascular disease?

The outlook for peripheral vascular disease is good if appropriate treatment is received. Complications of untreated or poorly controlled peripheral vascular disease can be serious, even life threatening in some cases. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of peripheral vascular disease include:

  • Adverse effects of treatment

  • Amputation

  • Blood clots or emboli that block off small arteries

  • Gangrene

  • Open sores on the lower legs (ischemic ulcers)

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Nov 18
  1. Peripheral artery disease. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Peripheral-Artery-Disease-ATH_...
  2. Explore peripheral arterial disease. National Heart, Lung, and Blood Institute Diseases and Conditions Index. http://www.nhlbi.nih.gov/health/dci/Diseases/pad/pad_what.html
  3. Aboyans V, Criqui MH, Denenberg JO, et al. Risk factors for progression of peripheral arterial disease in large and small vessels. Circulation 2006; 113:2623.
  4. Bope ET, Kellerman RD (Eds.) Conn’s Current Therapy.Philadelphia: Saunders, 2012.
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