Peripheral Vascular Disease
How common is peripheral vascular disease and why is it important?
The prevalence of peripheral vascular disease (PVD) in people aged over 55 years is 10%–25% and increases with age. Despite its prevalence and cardiovascular risk implications, only 25 percent of PVD patients ever undergo treatment. This lack of treatment is at least partially explained by the fact that over 50% of affected individuals are asymptomatic. While many people are “asymptomatic,” frequently there are findings on physical exam that your doctor may notice allowing the diagnosis to be made. Symptomatic PVD increases with age, from about 0.3% per year for men aged 40–55 years to about 1% per year for men over 75 years old. Diagnosis is critical, as people with PVD not only have possible treatable symptoms, but both symptomatic and asymptomatic patients have a four to five times higher risk of heart disease and stroke and appropriate therapy can decrease this risk.
What can I notice if I have peripheral arterial disease?
Peripheral arterial disease (PAD) involving the lower extremity arteries is a relatively common condition that is significantly under-diagnosed. The most classical symptom is an aching or pain in the muscles of the calf, thigh, or buttock associated with walking. Classically these symptoms are reproducible with the same distance walked. Other findings include diminished hair growth or change in color (blueness, paleness, or redness) or temperature (coolness) of the affected limb. More severe symptoms of lower extremity occlusive disease may include pain at rest or non-healing ulceration of the foot or toes. Less commonly the upper extremities may be affected resulting in easy and early fatigue of your arms with repetitive activities.
What are the risk factors for peripheral arterial disease?
Peripheral arterial disease has a number of important risk factors. While it is more common to have peripheral arterial disease with advancing age, the most important risk factors include cigarette smoking, diabetes mellitus and high cholesterol. Smoking increases up to tenfold the relative risk for PAD, while diabetes increases your risk fourfold. Other risk factors include high blood pressure and history of coronary artery disease (CAD). Less commonly, PAD can result from inflammatory disorders such as Takayasu’s arteritis, giant cell arteritis, or other types of vasculitis.
How does peripheral arterial disease occur?
Atherosclerosis is the major cause of PAD. As cholesterol plaque is incorporated into one’s arteries, the vessel eventually starts to narrow. Diabetes and smoking can significantly damage the vessel wall and accelerate plaque development and narrowing. The most significant areas of blocks occur at branch points of the arteries: the aortoiliac segment, the femoral popliteal segment or the tibial outflow segment. A patient may have disease isolated to a single segment or have multilevel disease. Diabetics more commonly have disease affecting the smaller vessels below the level of the knee. Symptoms associated with atherosclerosis may occur very gradually over long periods of time as the vessel progressively narrows. This process correlates with an individual’s progressive decrease in walking distance until their activities are almost sedentary. Some people may attribute this decline to "arthritis" or simply being "out of shape."
How can PAD be diagnosed?
Once PAD is suspected by your doctor, either because of symptoms or physical exam findings, diagnostic testing is recommended. The first line of testing is Ankle-Brachial Index (ABI) testing. If this test is abnormal, non-invasive pulse volume recordings or Doppler interrogation of the arteries are utilized. Next, magnetic resonance imaging (MRI/MRA) as well as invasive tests such as angiograms may be required. The information obtained from these specialized vascular studies will delineate the severity and extent of the occlusive process.
What can be done to treat Peripheral Artery Disease?
Most patients with PAD can be managed conservatively with exercise and medication. Risk factor modification may also help to stabilize their disease. Patients with more severe symptoms or limb threatening arterial insufficiencey require a more aggressive approach. Peripheral interventional treatment options include balloon angioplasty, stenting and laser atherectomy or a combination of these therapies. A balloon-tipped catheter is inserted into the artery and threaded to the narrowing or blockage. The balloon is inflated and then removed after pressing the plaque against the artery walls. Once the artery is open, a collapsed stent is next frequently inserted, holding the artery open. If vascular surgery is necessary, you can be referred to an excellent vascular surgeon. Open surgery may be the only option for longer or more severe blockages. This treatment uses a bypass graft to reroute blood around a blocked artery.