Peripheral vascular disease (PVD) is a condition that affects the blood vessels outside of the heart and brain. PVD can cause tissue and organ death, becoming a medical emergency. Find out if you are at risk for developing PVD and what you can do to improve your vascular health.

What is Peripheral Vascular Disease?

Peripheral vascular disease, or PVD, occurs when circulation to areas outside the heart and brain is reduced. The term peripheral, in healthcare, refers to any structure or bodily function occurring away from the central source. The heart and lungs are the central sources in our body, and our arms and legs are peripheral. The most common causes of peripheral vascular disease are narrowing or hardening of the arteries and veins, which limit the blood flow to the outside areas of the body. If the narrowed areas occur at the knee, everything below it will also be affected, and so forth.

Peripheral vascular disease can also affect circulation to organs besides the heart and brain, such as the stomach, intestines, and kidneys. When this happens, tissues are starved from oxygen and do not function properly. If the disease progresses and blood flow is cut off, the tissues will eventually die. The affected organs will fail, creating a medical emergency. PVD can also occur from vascular spasms.

Risk Factors for Peripheral Vascular Disease

According to the Center for Disease Control, 12% to 20% of people ages 60 and over get peripheral arterial disease (PAD), the most common type of PVD. This equates to roughly 8.5 million people. Some people are more likely to develop peripheral vascular disease than others because of their age, genetic makeup, lifestyle factors, or medical history.

Risk factors for functional PAD without damage include:

  • Cold climate:  People who live in colder climates are more likely to develop PVD due to increased exposure to cold. This is especially true for people with Raynaud’s phenomenon, a condition that causes blood flow to decrease when they are exposed to cold temperatures.
  • Excessive and long exposures to vibration, such as tools and machinery: Any activity that puts a lot of stress on the arteries can cause damage and an increased risk for PVD. Extended work with vibration, like driving large equipment and construction, increases the risk of developing vascular diseases like PVD and PAD. Workers using tools with the frequency range of 60-300 Hz are more likely to develop symptoms like reduced feeling, loss of manual dexterity, and vasospasms induced by cold weather.
  • Prolonged stress:  Prolonged stress increases the risk of developing vascular disease. Stress causes your blood pressure to rise, and this puts additional pressure on your veins.
  • Certain drugs and medications:  Some drugs can cause vasoconstriction (narrowing of the blood vessels) and increase your risk for PVD. These include alpha-adrenoceptor agonists, vasopressin analogs, epinephrine, norepinephrine, phenylephrine (Sudafed PE), dopamine, dobutamine, and migraine and headache medications ( serotonin 5‐hydroxytryptamine agonists or triptans).

The organic form of PVD involves damage to the blood vessels by plaque deposits or thickening of the vessel walls.

Risk Factors for this type of PVD include:

  • Smoking: Smoking is associated with an increased risk of developing vascular disease, including peripheral arterial disease. Chronic constriction of blood vessels can occur and smokers are more likely to have early signs of atherosclerosis (hardening or narrowing of the arteries). It also weakens the walls of arteries and veins, increasing the risk for clots and PAD.
  • Uncontrolled Diabetes: Diabetes can also increase the risk of developing vascular disease. Sticky build-up in vessels can occur and blood clots often adhere to the surface of these veins.
  • Elevated Cholesterol: High cholesterol levels are associated with atherosclerosis and coronary heart disease, which can cause peripheral arterial disease by clogging the vessels. Fat deposits collect within arteries and veins resulting in clogs and decreased blood flow.
  • Infections: Infections of the blood vessels can develop from bacterial infections, such as endocarditis, and fungal infections. These infections cause chronic inflammation within blood vessels.
  • Major Injuries: Damage to the artery wall from an injury, such as during an accident or fall, can cause major trauma. Injuries can lead to structural abnormalities in veins and blood vessels.

Increased risk factors for getting the disease also include:

  • Genetics: Some rare genetic conditions are associated with an increased risk of developing vascular disease.
  • History of blood clots or strokes: People who have had blood clots or strokes are at increased risk of developing vascular disease.
  • Pregnancy: Preeclampsia during pregnancy can cause damage to the artery walls that increases the risk of getting PVD later in life.
  • Obesity: Obesity is often associated with type II diabetes, which is linked to PVD.
  • Prior History of Blood Clots or Stroke: People who have had blood clots or strokes are at increased risk of developing vascular disease.
  • Family History: Some types of vascular disease, including PVD, are known to run in families. Genetic studies have shown several genes linked with an increased risk of venous insufficiency.
  • Hypertension: High blood pressure is a major risk factor for developing vascular disease. It puts additional stress on your arteries and veins, which can cause damage and plaque buildup in the blood vessels.
  • Exposure to Chemical Substances: Exposure to harmful chemicals is known to cause damage and increase the risk of developing atherosclerosis, resulting in PVD.
  • Age: As we age, our risk for developing PVD increases. Aging causes the arteries and veins to become less flexible, which increases the risk of damage and plaque buildup.

Signs and Symptoms of PVD

Symptoms of PVD happen as a result of the lack of oxygen and nutrients to tissues from decreased blood flow.  A good example is to describe how it feels when your hand or foot is asleep. Chances are there is pain, numbness, and tingling. The skin may also lose its pink and healthy appearance, and even turn blue from lack of oxygen. Over time you may lose feeling in the area and may not know if you have cut or injured yourself, leading to slow healing and infections. If PVD involves internal organs, you will experience signs and symptoms related to poor organ function.

Symptoms of Peripheral Vascular Disease:

  • Decreased skin temperature
  • Thin, brittle, or shiny skin
  • Hair loss on legs
  • Wounds that won’t heal
  • Muscle numbness or heaviness
  • Impotence
  • Restricted mobility
  • Severe pain
  • Thick, discolored toenails
  • Extremities with a reddish-blue hue

How is Peripheral Vascular Disease Diagnosed?

Diagnosing peripheral vascular disease (PVD) involves a detailed process to ensure an accurate assessment of the patient’s condition.

Referral and Symptoms: Often, patients are referred by primary care physicians, endocrinologists, or podiatrists. However, some individuals seek consultation independently, driven by persistent symptoms that impact their daily lives.

Initial Examination: The diagnostic journey begins with a thorough evaluation. Physicians will:

  • Check Pulse: Assess the pulse in the legs and feet to detect any irregularities.
  • Blood Flow and Pressure: Measure blood flow and pressure in the extremities to identify potential blockages or abnormalities.
  • Physical Assessment: Examine the skin, hair, and nails for changes in color or texture, and inspect for non-healing wounds, which can be indicative of PVD.

Ankle-Brachial Index (ABI): A commonly used diagnostic tool is the ankle-brachial index (ABI). This test compares the blood pressure in the ankle with the blood pressure in the arm. Differences in the readings can suggest the presence of PVD.

Additional Tests: Depending on the initial findings, further tests may be recommended, such as:

  1. Doppler Ultrasound: To visualize blood flow in the arteries.
  2. Angiography: For a detailed look at the blood vessels.
  3. Blood Tests: To check for underlying conditions that may contribute to PVD.

By implementing these diagnostic steps, healthcare professionals can accurately diagnose peripheral vascular disease and formulate an effective treatment plan.

What is the Outlook for Patients Diagnosed with Peripheral Vascular Disease?

Early Diagnosis and Treatment

Patients who are diagnosed with peripheral vascular disease (PVD) in its early stages often have a favorable outlook. With timely intervention and adherence to prescribed treatments, many individuals experience significant improvements. Lifestyle changes, such as quitting smoking and maintaining a healthy diet, are crucial for recovery and long-term management.

Advanced Stages and Critical Limb Ischemia

When PVD progresses to critical limb ischemia, the condition becomes more severe, and treatments become more complex. At this stage, a multidisciplinary approach is often required, involving:

  • Vascular specialists
  • Podiatrists
  • Wound care experts

Holistic treatment from these doctors aims to prevent further complications and optimize limb salvage.

Long-term Management

Consistency in following medical advice is key to managing PVD efficiently. Regular monitoring and follow-up appointments are essential to assess the effectiveness of treatments and make necessary adjustments. In addition, incorporating regular exercise and medication compliance can significantly improve one’s quality of life.

What Are the Potential Consequences if Peripheral Vascular Disease Goes Untreated?

Ignoring peripheral vascular disease (PVD) can lead to serious health concerns. If left without proper treatment, the condition might escalate to a critical stage known as critical limb ischemia (CLI).

Potential consequences include:

  • Severe Pain: Progression of PVD can cause recurring pain in the limbs, even when at rest.
  • Non-Healing Wounds: The affected limb might develop ulcers or sores that are slow to heal or do not heal at all.
  • Tissue Death: Due to restricted blood flow, tissues can start to die, increasing the risk of infections.

If critical limb ischemia develops:

  • Significant Risk of Amputation: CLI can be so severe that it may necessitate the amputation of the affected limb to prevent further health complications.

Early detection and management are crucial to avoid these severe outcomes. Proper medical intervention can alleviate symptoms and prevent the disease from worsening.

Lifestyle Changes that Prevent PVD

If you fall into a risk category for PVD or have already been diagnosed with Peripheral Vascular Disease, there are several things you can do to help prevent or slow the process of developing the condition:

Peripheral Vascular Disease - Vein Center

  • Maintain a healthy weight: A stable body mass index (BMI) is important to keep the blood flowing.
  • Keep active: As little as 15 minutes of activity each day can make a difference. Keep moving and get up to stretch every 30 minutes.
  • Improve diet: Reduce your intake of saturated fats, trans fats, and simple sugars that can lead to obesity which is a risk factor for developing PVD. A low-fat diet with limited foods high in cholesterol is best. If you are diabetic, it is very important to manage your blood sugar levels.
  • Quit smoking: Smoking causes damage throughout the body including blood vessels which increases your risk for vascular diseases.
  • Manage a medical condition: If you have a chronic disease, such as diabetes or high blood
    pressure, make sure to take your medications and follow your doctor’s instructions. This will help reduce the risk of cardiovascular diseases that can lead to PVD.

Peripheral Artery Disease Treatment Guidelines (2024)

The 2024 guidelines for the management of Lower Extremity Peripheral Artery Disease (PAD) from the American College of Cardiology (ACC) and the American Heart Association (AHA) offer comprehensive, evidence-based treatment recommendations to clinicians. Treatment guidelines include comprehensive care for PAD and PVD to help patients have a better quality of life. The recommendations to guide clinicians in deciding patient treatment include:

  1. Risk Factor Management:
    • High-intensity statin therapy is recommended to achieve a ≥50% reduction in LDL-C levels. For those already on maximal statin therapy with LDL-C ≥70 mg/dL, adding PCSK9 inhibitors or ezetimibe is advised.
    • Antihypertensive therapy aims to keep blood pressure below 130/80 mm Hg, with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers preferred.
  2. Medical Therapies:
    • For symptomatic PAD patients or those who have undergone revascularization, low-dose rivaroxaban (2.5 mg twice daily) combined with low-dose aspirin is recommended to reduce major adverse cardiovascular and limb events.
    • Full-intensity oral anticoagulation is not recommended unless there is another indication, such as atrial fibrillation.
  3. Diabetes and Smoking Cessation:
    • Glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors are effective in reducing major adverse cardiovascular events in diabetic PAD patients.
    • Structured programs for smoking cessation are strongly encouraged, as smoking affects blood flow.
  4. Exercise Therapy:
    • Supervised exercise therapy and structured community-based exercise programs are recommended to improve walking performance and quality of life.
    • Alternative non-walking exercises like using an arm ergometer can also be beneficial.
  5. Revascularization:
    • Revascularization is recommended for patients with chronic limb-threatening ischemia (CLTI) to minimize tissue loss and heal wounds. It is also advised for improving walking function and quality of life in patients with claudication that doesn’t respond to medical therapy and exercise.
  6. Health Disparities:
    • The guidelines address health disparities, noting that Black adults in the U.S. often face more advanced stages of PAD and higher rates of complications. Efforts are recommended to improve early detection and equitable access to treatments.
  7. Multispecialty Care:
    • A collaborative approach involving multiple specialties is emphasized to address the various aspects of PAD, from risk factor management to revascularization, aiming to optimize patient outcomes.

These guidelines incorporate the latest research and aim to improve comprehensive care for individuals with PAD, focusing on reducing complications and improving quality of life​.

Schedule An Appointment at The Vein Centre

If you feel that you are at risk, or are developing signs and symptoms of the condition, your Tennessee vein specialists at The Vein Centre can help you find the most appropriate treatment for your situation.