The following information was prepared by the Society of Cardiovascular & Interventional Radiology (SIR) to provide general information for consumers on PVD (www.sirweb.org).
Q: What is peripheral vascular disease?
Peripheral vascular disease, or PVD, is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain but often causing no symptoms at all.
The most common cause of PVD is atherosclerosis (often called hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that clogs the blood vessels. In some cases, PVD may be caused by blood clots that lodge in the arteries and restrict blood flow.
Q. How common is PVD?
PVD affects about 1 in 20 people over the age of 50, or 10 million people in the United States. More than half the people with PVD experience leg pain, numbness or other symptoms — but many people dismiss these signs as "a normal part of aging" and don't seek medical help. Only about half of those with symptoms have been diagnosed with PVD and are seeing a doctor for treatment.
Incidence of Peripheral Vascular Disease (PVD):
- PVD affects 10 million people in the United States including 5% of the over 50 population
- Only a quarter of PVD sufferers are receiving treatment
- Symptomatic constitutes 50% of cases (5 million)
- Of these, 2.5 million go undiagnosed
- Of the 2.5 million diagnosed cases, 2.1 million are medically managed (e.g. exercise)
Q. What are the symptoms of PVD?
The most common symptom of PVD is painful cramping in the leg or hip, particularly when walking. This symptom, also known as "claudication," occurs when there is not enough blood flowing to the leg muscles during exercise. The pain typically goes away when the muscles are given a rest.
Other symptoms may include numbness, tingling or weakness in the leg. In severe cases, you may experience a burning or aching pain in your foot or toes while resting, or develop a sore on your leg or foot that does not heal. People with PVD also may experience a cooling or color change in the skin of the legs or feet, or loss of hair on the legs. In extreme cases, untreated PVD can lead to gangrene, a serious condition that may require amputation of a leg, foot or toes. If you have PVD, you are also at higher risk for heart disease and stroke. Unfortunately, the disease often goes undiagnosed because many people do not experience symptoms in the early stages of PVD or they mistakenly think the symptoms are a normal part of aging.
Q. Who is at risk for PVD?
As many as 8 million people in the U.S. may have PVD. The disease affects everyone, although men are somewhat more likely than women to have PVD.
Those who are at highest risk are:
- over the age of 50
- people who do not exercise
- people who have high blood pressure or high cholesterol
- A family history of heart or vascular disease may also put you at higher risk for PVD.
Q: How can PVD be treated?
The best treatment for PVD depends on a number of factors, including your overall health and the seriousness of the disease. In some cases, lifestyle changes are enough to halt the progress of PVD and manage the disease. Sometimes, medications or procedures that open up clogged blood vessels are prescribed to treat PVD.
In many cases, changes in lifestyle are enough to slow the progression or even reverse symptoms of PVD. Most treatment plans will include a low fat diet and a program of regular exercise.
If you are a smoker, it is absolutely essential that you stop the use of all types of tobacco.
If decreased blood flow to the legs is causing injury to the feet and toes, a foot care program to prevent sores or infection may be prescribed. This may include referral to a podiatrist.
Research has shown that regular exercise is the most consistently effective treatment for PVD. In study after study, patients who have taken part in a regular exercise program for at least three months have seen substantial increases in the distances they are able to walk without experiencing painful symptoms. Exercise programs that have been effective include simple walking regimens, leg exercises and, most commonly, treadmill exercise programs three to four times every week for a period of several months. Some people may have a medical condition that prevents them from participating in an exercise program. Consult with your physician before undertaking any exercise or other treatment program.
Like many patients with coronary artery disease caused by atherosclerosis, PVD patients frequently have elevated cholesterol levels that contribute to the disease. A low fat diet and other cholesterol-lowering strategies are often part of a treatment plan.
There is no doubt that cigarette smoking is a strong risk factor for PVD. On average, smokers are diagnosed with PVD as much as 10 years earlier than non-smokers. Stopping smoking now is the single most important thing you can do to halt the progression of PVD or prevent it in the future.
For many patients, lifestyle changes combined with medication can control the symptoms of PVD. Drugs that lower cholesterol or control high blood pressure may be prescribed. New medications that help prevent blood clots or the build up of plaque in the arteries, or that reduce the pain of PVD, also are appropriate for some patients.
Procedures to Open Blocked Blood Vessels
There are a number of ways that physicians can open blood vessels at the site of blockages and restore normal blood flow. In many cases, these procedures can be performed without surgery using modern, interventional radiology techniques. Interventional radiologists are physicians who use tiny tubes called catheters and other miniaturized tools and X-rays to do these procedures.
Sometimes, open surgery is required to remove blockages from arteries or to bypass the clogged area. These procedures are performed by vascular surgeons.
Interventional Radiology Treatments for PVD
Angioplasty - a tiny balloon is placed in the blood vessel at the site of the blockage. It is then inflated to open the blood vessel.
Stents - a tiny metal cylinder, or stent, is inserted in the clogged vessel to act like a scaffolding and hold it open.
Thrombolytic therapy - clot-busting drugs are delivered to the site of blockages caused by blood clots.
Stent-grafts - a stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.
Angioplasty - In this procedure, an interventional radiologist inserts a very small balloon attached to a thin tube (catheter) into a blood vessel through a small (1/4 inch) nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery.
In some cases, a stent—a tiny cylinder made of metal mesh—is inserted and left behind in the artery to keep it open.
Thrombolytic Therapy - This treatment is used by an interventional radiologist if the blockage in the artery is caused by a blood clot. Thrombolytic drugs—sometimes called "clot busters"—dissolve the clot and restore blood flow. Usually, the drugs are administered through a catheter directly into the clot. These drugs are frequently combined with another treatment, such as angioplasty.
Surgical Treatments for PVD
Most cases of PVD can be treated with lifestyle changes; medications; non-surgical, interventional radiology procedures; or some combination of these treatments. In some severe cases, however, surgery may be required. Procedures performed by a vascular surgeon include:
Thrombectomy - This procedure is used only when symptoms of PVD develop suddenly as a result of a blood clot. In the technique, a balloon catheter is inserted into the affected artery beyond the clot. The balloon is inflated and pulled back, bringing the clot with it. Thrombectomy usually requires surgery.
Bypass grafts. In this procedure, a vein graft from another part of the body or a graft made from artificial material is used to create a detour around a blocked artery.
Q: How do I know which treatment will be the best for me?
The best treatment for PVD depends on a number of factors, including your overall health, the location of the affected artery, and the size and cause of the blockage or narrowing in the artery. You should discuss all your treatment options with your physician.
Some questions to ask:
- Can my PVD be controlled with lifestyle changes?
- What medications might be appropriate for me?
- If a procedure is required, am I a candidate for a less invasive, interventional radiology treatment?
- What are the risks and benefits of the treatment plan prescribed for me?
Q. What is an interventional radiologist?
Interventional radiologists are physicians who have special training to diagnose and treat conditions using tiny, miniaturized tools while watching their progress using moving X-rays or other imaging techniques.
Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for patients than surgery because they involve no surgical incision, less pain and shorter hospital stays. Your interventional radiologist will work closely with your primary care or other physician to be sure you receive the best possible care.
For more information regarding interventional radiology, please visit: www.sirweb.org.