Peripheral Vascular Disease

Frequently Asked Questions

What is peripheral vascular disease?
Peripheral vascular disease (PVD) refers to a partial or complete blockage of blood vessels that supply blood to other important areas of the body: the legs, brain, kidneys or arms. A narrow or blocked artery, whether in the heart or in another part of the body, is a risk factor for heart attack and stroke.

What causes peripheral vascular disease?
Peripheral vascular disease is caused by atherosclerosis — plaque — that builds up and causes a narrowing or blockage in blood vessels. Risk factors for the development of plaque include high cholesterol, high blood pressure, smoking, inactivity and diabetes.

What are the symptoms of peripheral vascular disease?
More than half of individuals with peripheral vascular disease experience numbness, cramps or leg pain, but many attribute these symptoms to the normal process of aging and don't seek medical help. It is estimated that only one quarter of people with PVD are receiving treatment.

Who is at risk for peripheral vascular disease?
Peripheral vascular disease affects one in 20 individuals over the age of 50 or about 10 million people in the United States. PVD can cause gangrene, which is a serious condition that may require amputation of a leg, foot or toes. People with the disease also are at higher risk for heart disease and stroke or problems with the circulatory system in the brain or kidneys.

What other risk factors exist with peripheral vascular disease?
PVD and abdominal aneurysm have risk factors similar to those for heart attack and stroke. People with PVD or aneurysm have a risk that is three to four times higher for heart attack and stroke than people without PVD or aneurysm.

Each of these conditions — along with diabetes — is called a coronary heart disease risk equivalent. A risk equivalent increases your risk for having a heart attack. For example, if you have any of the following conditions, your risk for having a heart attack over the next five to 10 years is as high or higher than someone who has already had a heart attack:

  • Diabetes, adult onset
  • Peripheral vascular disease
  • Abdominal aortic aneurysm
  • Stroke or brain artery blockage in the neck
  • Chronic kidney failure
  • Major uncontrolled risk factors

If you have PVD, it is important to have comprehensive treatment of all of your risk factors, even if your cholesterol is not very high, your blood pressure is controlled, and you have never smoked or have stopped smoking.

Prevention Guidelines

It is important to be aware of risk factors that can lead to the development of cardiovascular (heart and blood vessel) disease, which, in turn, increases your risk of having a heart attack or stroke.

There are risk factors that you can control as well as risk factors you cannot control.
Risk factors you can control including the following:

  • Smoking
  • Being overweight
  • An inactive lifestyle
  • High LDL levels
  • Low HDL levels
  • High triglyceride levels
  • High blood pressure
  • Diabetes
  • Stress

Risk factors you cannot control include:

  • Your age. You are at risk of a heart attack or stroke if you are male and older than 45. If you are female, your risk increases after age 55.
  • Your gender. More men have heart attacks earlier in life, but more women than men die from cardiovascular disease.
  • Your family history. A family history of cardiovascular disease puts you at risk of developing the disease.
Diagnosing Peripheral Vascular Disease

During a medical history and physical exam, your physician will ask you about symptoms you may be experiencing. He or she may listen for a weak pulse in the arteries in your arms and legs, which may indicate the presence of PVD.

To confirm a diagnosis of PVD, your physician may have you undergo one or several of the following procedures:

Ankle/brachial index (ABI)
This simple, noninvasive procedure compares the ratio of blood pressure in the arms and legs. An abnormal ratio between the two may indicate decreased circulation in blood vessels.

Ultrasound
An ultrasound procedure uses sound waves to produce images of blood flowing through arteries.

64-Slice CT angiography
During this noninvasive test, a CT scanner (a type of X-ray machine) rotates around the body taking a series of images. These images are then reconstructed on a computer and provide detailed pictures of arteries and other body structures.

Arteriography
During this procedure a contrast dye is injected into a blood vessel, which allows physicians to see areas of blockage on a monitor. This procedure may be used in conjunction with endovascular treatment (balloon angioplasty and stent placement).

Treating Peripheral Vascular Disease
Virginia Mason's team of interventional radiologists, vascular surgeons and interventional cardiologists all work together to treat patients with PVD. Treatment will depend on your symptoms and the severity of your disease as well as your overall general health. Treatment options include:

Lifestyle modifications
If a blockage is not severe, it may be controlled with lifestyle modifications that include losing weight, exercising and stopping smoking.

Minimally invasive endovascular interventions (transcatheter intervention)
Your physician may recommend that you have a balloon angioplasty procedure and a stent placed in the blocked blood vessel to help keep it open to blood flow. During this procedure you will first be given a local anesthetic and medications to help you relax. Next, after a small incision is made in your arm or leg, a guide wire will be inserted into an artery and gently maneuvered toward the blockage. When the guide wire reaches the blockage, a thin catheter with a balloon on its end is moved over the wire to the affected area. The balloon is then inflated within the blockage, which helps open the artery.

The balloon may remain inflated for up to two minutes, then deflated. It also may be inflated several times to achieve the desired result. You may feel some mild pressure in your arm or leg and in the area of the blockage during the procedure, which is normal. A stent, which is a small wire mesh coil, is then placed in the artery where the blockage occurred to help keep it open.

Surgery
Peripheral vascular bypass
Your physician may recommend that you have surgery to bypass a blocked blood vessel. This procedure involves taking a vein from another part of your body to be used as a bypass graft. An incision is then made in your arm or leg to access the blocked blood vessel. The graft is sewn above and below the blockage, allowing blood to bypass the obstruction. 

Endarterectomy
This surgery is often used to remove blockage from the carotid arteries on either side of the neck. For this surgery you will first have a local or general anesthetic. After a small incision is made in the neck, the artery will be opened and the blockage cleaned out. Your surgeon may decide to insert a graft (part of a vein or a man made material) to help keep the artery open. The artery is then sewn shut.