Peripheral Vascular Disease

Peripheral vascular disease refers to any disease or disorder of the circulatory system outside of the brain and heart. Although the term peripheral vascular disease can include any disorder that affects any of the blood vessels, it often is used as a synonym for peripheral artery disease.

Peripheral vascular disease is the most common disease of the arteries. It is caused by build-up of fatty material within the vessels, called atherosclerosis. Another name for this condition is arteriosclerosis, or hardening of the arteries.

This is a gradual process in which the artery gradually becomes blocked, narrowed or weakened. When this condition affects the arteries of the heart, it is called coronary heart disease (coronary artery disease).

The most common symptom of peripheral vascular disease in the legs is pain in one or both calves, thighs or hips.

Symptoms

The pain usually occurs while you are walking or climbing stairs and stops when you rest. This is because the muscles' demand for blood increases during walking and other exercise. The narrowed or blocked arteries cannot supply more blood, so the muscles are deprived of oxygen and other nutrients.

This pain is called intermittent (comes and goes) claudication. It is usually a dull, cramping pain. It may also feel like a heaviness, tightness, or tiredness in the muscles of the legs.

Cramps in the legs have several causes, but cramps that start with exercise and stop with rest most likely are due to intermittent claudication. When the blood vessels in the legs are completely blocked, leg pain at night is very typical, and the individual almost always hangs his or her feet down to ease the pain. Hanging the legs down allows for blood to passively flow into the distal part of the legs.

Other symptoms of peripheral vascular disease include the following:

Buttock pain

Numbness, tingling, or weakness in the legs

Burning or aching pain in the feet or toes while resting

A sore on a leg or a foot that will not heal

One or both legs or feet feel cold or change color (pale, bluish, dark reddish)

Loss of hair on the legs

Impotence

Having symptoms while at rest is a sign of more severe disease.

How is peripheral vascular disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for peripheral vascular disease may include any, or a combination, of the following:

Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing of the vessels. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.

Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device.  To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.

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. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Doppler technique is used to measure and assess the flow of blood. Faintness or absence of sound may indicate an obstruction in the blood flow.

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 the body. An MRA is often used to examine the heart and other soft tissues and to assess blood flow.

Treadmill exercise test. This test is given while a patient walks on a treadmill to monitor the heart during exercise.

Photoplethysmography (PPG). This examination is comparable to the ankle brachial index except that it 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. These measurements are then compared 
to the systolic blood pressure in the arm.

Pulse volume recording (PVR) waveform analysis. This technique is used to calculate blood volume changes in the legs using a recording device that displays the results as a waveform. 

Reactive hyperemia test. This test is similar to an ABI or a treadmill test but used for people who are unable to walk on a treadmill. While a person is lying on his or her back, comparative blood pressure measurements are taken on the thighs and ankles to determine any decrease between the two sites. 

Segmental blood pressure measurements. This is a means of comparing blood pressure measurements using a Doppler device in the upper thigh, above and below the knee, at the ankle, and on the arm to determine any constriction in blood flow.

Contact your healthcare provider if you have questions about PVD. For a Holy Cross physician referral, call 1-866-4HC-DOCS or Find a Provider at holy-cross.com. 

To learn more about Holy Cross Interventional Radiology (one specialty that treats PVD), click here.