Peripheral Vascular Disease

Peripheral vascular disease (PVD), also known as peripheral arterial disease (PAD), is a disease of the circulation that often affects the legs but can involve many other parts of the body. People with PVD have areas of narrowing or blockages of their arteries which prevent adequate circulation in the affected body part. About 10 million persons in the United States are afflicted with this disease every year. Tobacco use, high blood pressure, high cholesterol and diabetes increase an individuals risk for developing PVD.

Symptoms

The most common symptom of PVD is a cramping type of pain of the legs, hips or buttocks when walking. The pain usually gets better after a period of rest. Other symptoms include numbness, weakness or a tingling sensation when attempting to walk. In more severe cases patients can have pain in the legs even while at rest and can develop wounds of the feet which do not heal. In the most severe cases a persons feet or legs can become cold, pale and numb. This can eventually lead to gangrene which will require amputation of the affected part of the foot and/or leg.

Diagnosis

A non-invasive vascular study can be ordered by your physician which will calculate your ABI's (ankle-brachial indices). This is a quick and painless screening exam which will determine your probability of having peripheral vascular disease. If this study is positive further evaluation of your arterial circulation can be performed with a special type of MRI called "magnetic resonance angiography" (MRA). This study will show which particular arteries are narrowed or blocked. For patients who prefer not to have an MRI a special type of CAT scan called a CTA can be performed.

Treatment Options

Lifestyle changes such as exercise and smoking cessation are usually the first line of defense against PVD. Regular exercise is especially helpful in increasing the distance that a person can walk before cramping occurs. In addition, new medications have become available recently which may help increase walking distance.

Unfortunately, PVD often becomes severe enough that these initial measures are not adequate. In the past, patients in this situation often had to undergo surgery to improve blood flow to their legs. The three main types of surgery performed for PVD are bypasses, endarterectomy and embolectomy. All of these surgeries require that incisions be made in the operating room. In a bypass, the most common type of surgery, a piece of vein or a synthetic tube is used to re-route blood around a blockage or narrowing much like a detour routes traffic around an obstacle such as construction. Surgery can be very effective at relieving or improving the symptoms of PVD. Unfortunately, surgery caries with it significant risks such as infection, serious bleeding or, uncommonly, death. In addition, surgery often requires a stay in the hospital and a prolonged recovery period.

The physicians at Valley Endovascular Associates are able to open many blocked or narrowed arteries with the non-surgical techniques known as angioplasty and stenting. Angioplasty is performed by inserting a catheter, a thin spaghetti sized tube, with a balloon attached to its tip, into a blood vessel through a small nick in the groin area. Using x-ray guidance, the catheter is pushed forward and steered to the diseased vessel. The balloon is then inflated, causing the plaque which is responsible for the narrowing to crack. Often a stent, a metal mesh tube, is also inserted to keep the artery open. The stent is placed on the balloon so that when the balloon is inflated the stent is pressed against the walls of the blood vessel. When the balloon is deflated the stent remains in place to keep the vessel open.

These procedures do not require general anesthesia and patients can leave the hospital on the same day as the procedure. The recovery period is one day, after which people can return to their usual activities. The risk of having a complication such as serious bleeding, infection or death is much lower than it would be with traditional surgical techniques.