Peripheral Vascular Disease (PVD)
In healthy adults, blood flows freely through veins and arteries like a stream. However, when that stream gets gunked up, blood flow can be restricted. Peripheral vascular disease, or PVD, is a systemic disorder that involves the narrowing of peripheral blood vessels (vessels situated away from the heart or the brain) as a result of arteriosclerosis, or a buildup of plaque. This can happen with veins or arteries.
When plaque accumulates, it may result in blood clots and dangerously limit the amount of oxygen that circulates to the arms and legs. The condition often causes pain and discomfort while walking. If peripheral vascular disease goes untreated, there is a chance that it may progress into critical limb ischemia, a severe stage of PVD that can result in the loss of an affected limb. But if caught in its early stages, peripheral vascular disease is a treatable and reversible disease.
What are the risk factors for peripheral vascular disease?
Peripheral vascular disease is most commonly caused by smoking, high blood pressure, elevated cholesterol levels, and/or type 2 diabetes.
Men over the age of 50 and postmenopausal women are more likely to develop peripheral vascular disease. The likelihood increases if the patient is a smoker, overweight, sedentary, and/or has had any one or more of the following: diabetes, hypertension and/or kidney disease.
What are the symptoms of peripheral vascular disease?
Patients with peripheral vascular disease may experience no symptoms at first, and when symptoms begin to appear, they tend to be irregular and occur more often when a patient is active—especially when walking.
A patient may notice pain, cramping, and/or discomfort in his or her legs and feet. Other symptoms can include achiness, burning and fatigue.
If a patient’s peripheral vascular disease continues to progress, symptoms will probably occur with greater frequency and may manifest even when the patient is not walking or otherwise being active.
Other signs to watch for:
- Changes to the skin on the legs and feet, which can become thin and/or shiny
- A purplish tinge to arms and legs, or toes that become blue
- Wounds and ulcers appearing on the feet and legs
- Thinning of hair on the legs
How is peripheral vascular disease diagnosed?
“Patients are often referred to us by their primary care physician or an endocrinologist or podiatrist, but some have done their own research and decided to come in on their own,” says Carlos Mena, MD, an interventional cardiologist and a specialist in vascular medicine. “Usually they’re experiencing one or more life-limiting symptoms.”
The team at Yale Medicine conducts a comprehensive evaluation which includes checking the patient’s pulse, blood flow and pressure in the legs and feet. The specialist will also examine the hair, nails, and skin for irregularities suggestive of peripheral vascular disease, including color changes and wounds that won’t heal.
An ankle-brachial index, which compares blood pressure in a patient’s ankle with the blood pressure in the patient’s arm, is often performed.
How is peripheral vascular disease treated?
Dr. Mena was involved in clinical trials at Yale Medicine that have impacted the way peripheral vascular disease is treated throughout the United States.
“We work with the patient, the family, and the referring physician to put together a comprehensive treatment plan that would include multiple providers, all in an effort to minimize any disruption to the patient’s routine,” he says.
Therapy typically includes changes to diet and exercise, smoking cessation, and, if appropriate, medications including blood thinners to dissolve clots, statins to reduce cholesterol, and vasodilators, which widen the blood vessels.
While those treatments typically enable Dr. Mena and his team to avoid more invasive therapies, sometimes there is a need for surgical repair or unblocking of the blood vessels, also called angioplasty.
What is the outlook for patients with peripheral vascular disease?
Patients diagnosed early can typically expect a full recovery, provided that all treatments, including lifestyle changes such as quitting smoking, are adhered to over time.
Patients whose peripheral vascular disease has progressed to critical limb ischemia are seen at Yale Medicine’s multidisciplinary critical limb ischemia clinic.
“We see patients at the clinic from the tri-state area and beyond, with critical limb ischemia ulcers or who may be looking for a second opinion after being told they needed an amputation,” says Dr. Mena.
What makes Yale Medicine’s approach to treating peripheral vascular disease unique?
Yale Medicine has multiple ongoing clinical trials that are working to improve the outcomes for people with critical limb ischemia. “The clinical trials we do here have already resulted in new technology, new devices, and new approaches to treatment strategy,” Dr. Mena says.
Dr. Mena says doctors at the clinic also have a global perspective of PVD and critical limb ischemia. “We have a global vision,” Dr. Mena says, “We travel around the country and overseas, treating people with PVD and critical limb ischemia. We are engaged in and deeply committed to the development of programs that may affect how care is delivered in many places around the world.”