Peripheral Vascular Disease Guide: What You Need to Know
Peripheral vascular disease (PVD) affects more than 8 million in the United States. Peripheral means it involves vessels outside the heart. PVD is also known as peripheral artery disease, peripheral arterial disease, or PAD.
This article describes PAD, including its causes and risk factors.
In PAD, the arteries outside the heart narrow, which restricts blood flow. Reduced blood flow leads to symptoms such as weakness and muscle pain in the area the arteries supply. Atherosclerosis — the buildup of plaque in blood vessels — is the cause of the narrowing.
Having atherosclerosis in your peripheral vessels means you may also have it in your central vessels. These are the ones that supply your heart muscle and brain. Having atherosclerosis in these areas puts you at risk of heart attack and stroke.
- abdominal aorta
- iliac arteries, which branch in the pelvis to supply the legs
- upper extremity arteries, which supply the arms
Many people with PAD do not have any symptoms. When they do occur, the classic symptom is intermittent claudication. This is the medical term for pain, numbness, achiness, burning, heaviness, or cramping in the lower limbs. This occurs during activities such as walking or climbing stairs.
You may experience these symptoms in any of the lower limb muscles. This includes those in the feet, calves, thighs, or buttocks. This symptom usually decreases when you stop the activity and the muscles rest.
Other symptoms of PAD may include:
- burning, tingling, or a pins and needles sensation
- cool, pale, blue, or numb feet or legs
- decreased or absent pulse in the lower limbs
- hair loss, poor toenail growth, or hair growth on the legs
- muscle weakness or atrophy
- shiny skin
- resting pain, which is a sign of advancing disease
- sores or wounds on the lower limbs that heal slowly, poorly, or not at all
If you have PAD, you are also at risk of stroke or heart attack due to atherosclerosis. Seek immediate medical care by calling 911 if you have any of these potential symptoms of heart attack or stroke:
- blurred or double vision
- breathing problems, such as shortness of breath, difficulty breathing, or labored breathing
- chest pain, tightness, or pressure
- difficulty walking
- problems with memory, thinking, talking, comprehension, writing, or reading
- nausea with or without vomiting
- pain in the back, neck, jaw, or stomach
- severe or sudden headache
- sudden paralysis or muscle weakness
The main cause of PAD is atherosclerosis. Atherosclerosis is the buildup of plaque, consisting mostly of fat and cholesterol, in blood vessels.
Atherosclerosis starts with damage to blood vessels. The damage can occur from:
- high amounts of certain fats and cholesterol in the blood
- high blood pressure
- high amounts of sugar in the blood due to insulin resistance or diabetes
With atherosclerosis, plaque forms on the blood vessel walls where the damage occurred. Platelets, which are 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.
A number of factors increase the risk of developing PAD. However, not all people with risk factors will get the disease. Risk factors for PAD include:
- age of 65 years and older
- a diet high in saturated fats
- a family history of PAD, heart disease, stroke, or vasculitis
- high blood pressure
- high cholesterol or triglycerides
- obesity and metabolic syndrome
- sedentary lifestyle
You may be able to lower your risk of PAD by:
- controlling diabetes, high blood pressure, and high cholesterol or triglycerides
- eating a diet low in saturated fat, trans fat, and cholesterol
- exercising regularly
- losing weight if necessary
- quitting smoking
If your doctor suspects PAD, there is a simple, noninvasive test to diagnose it. An ankle-brachial index (ABI) measures the blood pressure in your ankles and compares it with the blood pressure in your arms. An index of 1.0 or greater is a healthy result. If it is less than 1.0 at rest, it indicates PAD.
Other tests that can help diagnose PAD include:
- blood tests to check cholesterol, triglyceride, and glucose levels
- Doppler ultrasound to measure how fast blood is flowing and identify areas of reduced blood flow
- exercise ABI to see if the index worsens or drops with activity
- a walking test to see how far you can walk in a set amount of time
Your doctor may order an angiogram to find the area of plaque buildup.
Treatment of PAD has several aims. The first is managing symptoms so you can stay active and improve your quality of life. The others are to lower the risk of losing a limb or having a heart attack or stroke.
Often, lifestyle modifications such as exercising and quitting smoking can successfully treat PAD. Depending on the severity and underlying cause, your doctor may also recommend medications or minimally invasive procedures.
Medications to treat peripheral vascular disease
Depending on your situation and risk factors, your doctor may prescribe medications from a number of different classes, including:
- antiplatelet drugs, which limit blood clot formation
- blood pressure medications, such as ACE inhibitors
- diabetes medications or insulin
- statins and other drugs that lower blood cholesterol levels
Procedures to treat peripheral vascular disease
If blood flow blockage is complete or nearly complete, your doctor may recommend one of the following procedures:
- angioplasty, which uses a balloon-like catheter to widen the blocked blood vessel and a small mesh tube, or stent, to keep it open
- bypass grafting
- thrombolytic therapy, which injects a clot-dissolving drug into the blood vessel to break up blood clots
With early treatment, the outlook for PAD is good. Complications of untreated or poorly controlled PAD can be serious. You can help minimize your risk of serious complications by following your treatment plan.
Complications of PAD include:
Contact your doctor if you have symptoms of PAD. However, people without symptoms can still have PAD. If you have risk factors, such as smoking or high blood pressure, contact your doctor for a PAD evaluation.
It is important to find out if you have PAD because it can lead to complications. It may also mean you have atherosclerosis other places, such as the coronary arteries.
Here are some questions people ask about peripheral vascular disease.
What is the most common peripheral vascular disease?
The most common form of peripheral vascular disease is lower extremity PAD. It can affect the feet, calves, thighs, or buttocks. Symptoms of lower extremity PAD can interfere with walking and other activities.
How long can you live with peripheral vascular disease?
With a dedication to lifestyle changes, you can effectively treat PAD. However, stroke and heart attack are potential complications. Up to 30% of people with PAD die within 5 years. Cardiovascular events cause most of these deaths. Your outlook depends on PAD severity and your risk factors.
PAD is a form of atherosclerosis. It affects arteries outside the heart and brain. Most commonly, PAD involves the arteries in the lower extremities. Reduced blood flow through these arteries causes pain with activities along with other symptoms in the feet and legs.
Lifestyle changes are a key part of PAD treatment. These same changes can help lower the risk of complications, such as heart attack and stroke. In some cases, doctors recommend medications or surgery to treat PAD.