Peripheral Vascular Disease

Finding peripheral vascular disease (PVD) at an early stage gives patients the opportunity to adopt lifestyle changes and take medication that can slow disease progression, reduce symptoms, and prevent serious complications. AHN is a leader in PVD early intervention.

What is peripheral vascular disease?

Peripheral vascular disease (PVD) describes any condition affecting blood vessels outside of the heart and brain. This means PVD can involve issues with arteries, veins, or even the lymphatic system. Essentially, PVD describes a diverse range of circulatory disorders not directly linked to cardiac or brain health, with varying underlying causes. It can be caused by clots, inflammation, or blockages in the body.

PVD is also sometimes referred to as peripheral artery disease (PAD).

Peripheral artery disease (PAD) is a specific type of PVD that is classified by the narrowing of arteries outside the heart and brain. It is almost always caused by atherosclerosis (plaque buildup in arteries).

PAD effects between 6.5 million and 12 million adults in the United States. Symptoms may not always be present, but risk factors include age, diabetes, high blood pressure, and smoking.

Peripheral vascular disease care at AHN: Why choose us?

When facing the complexities of PVD, the right care team can make all the difference. At AHN, we are committed to providing comprehensive, advanced, and patient-centered care for every stage of PVD. Patients and their families choose AHN for:

Expert, integrated vascular team: You'll benefit from a highly skilled and collaborative team of board-certified vascular surgeons, interventional radiologists, and interventional cardiologists. A multidisciplinary approach is designed so you can receive the most appropriate and effective treatment plan.
Advanced diagnostic capabilities: AHN uses state-of-the-art diagnostic imaging, including advanced vascular ultrasound, CT angiography, and MR angiography, to accurately identify the location and severity of arterial blockages and venous (vein) issues. This precise diagnosis is the foundation of an effective treatment strategy.
Comprehensive, leading-edge endovascular options: We specialize in advanced minimally invasive procedures such as angioplasty, stenting, and atherectomy, which offer faster recovery times and less discomfort.
Expert open surgical techniques: For complex cases or when endovascular options are not suitable, our experienced vascular surgeons perform intricate bypass surgeries and other open procedures with proven outcomes.
Robust medical management: Our team provides expert guidance on lifestyle modifications, risk factor management (diabetes, hypertension, cholesterol), and medication regimens essential for long-term vascular health and preventing disease progression.
Patient-centered approach: Your care journey begins with a thorough assessment and a personalized treatment plan tailored to your unique needs, symptoms, and lifestyle.
Commitment to research and innovation: As part of a leading academic health system, AHN is actively involved in clinical trials and research, bringing the latest advancements and innovative therapies directly to our patients. This means eligible patients have access to cutting-edge treatments often before they are widely available.

At AHN, we don't just treat PVD; we treat the whole patient, focusing on improving your mobility, quality of life, and overall cardiovascular well-being. Choose AHN for expert care that puts you first.

Peripheral vascular disease symptoms and signs

Given that PVD is a broad term encompassing various conditions affecting arteries, veins, and lymphatic vessels, the symptoms and signs can vary significantly depending on the specific type of PVD. However, there are some more common symptoms and signs that people with PVD and PAD experience. These often include:

Leg pain or cramping: This is a hallmark symptom, especially of Peripheral Artery Disease (PAD). It's typically described as muscle pain or cramping in the legs, thighs, or buttocks that occurs during activity (like walking or climbing stairs) and goes away after a few minutes of rest. The location of the pain often indicates where the artery is narrowed.
Numbness or weakness in the legs or feet: Reduced blood flow can lead to a lack of sensation or muscle weakness in the affected limb, even at rest.
Coldness in the lower leg or foot: One leg or foot, especially compared with the other side, may feel noticeably colder due to decreased blood circulation.
Sores that won't heal: Wounds, typically on the toes, feet, or legs, that heal slowly or not at all are a serious sign of poor circulation.
Change in skin color: The skin on the legs or feet may look pale, bluish (cyanotic), or reddish-brown due to inadequate blood supply.
Hair loss or slower hair growth: Reduced circulation to the legs and feet can lead to hair loss on the legs or slower growth of toenails.
Shiny skin: The skin on the legs can appear shiny, taut, or thin.
Weak or absent pulses: A health care provider may find a weak or absent pulse in the legs or feet during an examination.
Erectile dysfunction (in those assigned male at birth): PAD can be a cause of erectile dysfunction, especially if other symptoms are present.
Swelling in the limbs (edema): While often associated with venous conditions (like chronic venous insufficiency or deep vein thrombosis), significant swelling can also be a sign of some forms of PVD.

Causes and risk factors

Understanding the common risk factors and causes of PVD is crucial for both prevention and management. As PVD is a broad term, its causes and risk factors can vary depending on whether the condition primarily affects arteries, veins, or lymphatics. However, the most prevalent and concerning form of PVD is peripheral artery disease (PAD), which shares many risk factors with other cardiovascular diseases. The most common causes and risk factors for PVD and PAD include:

Atherosclerosis: This is by far the leading cause of PAD. Atherosclerosis is a disease in which plaque (a sticky substance made of cholesterol, fats, calcium, and other substances in the blood) builds up inside the arteries. This plaque hardens and narrows the arteries, limiting the flow of oxygen-rich blood to the organs and other parts of the body, most commonly the legs and feet in the case of PAD.
Smoking (and vaping): This is the most significant and preventable risk factor for PAD. Nicotine damages the walls of blood vessels, increases blood pressure, and promotes plaque formation and blood clot development.
Diabetes: High blood sugar levels from diabetes damage blood vessels throughout the body, making them more prone to narrowing and hardening. Diabetics often develop PAD at a younger age and experience more severe blockages.
High blood pressure (hypertension): Uncontrolled high blood pressure puts extra stress on artery walls, contributing to arterial damage and accelerating atherosclerosis.
High cholesterol (hyperlipidemia): High levels of LDL ("bad") cholesterol contribute directly to plaque buildup in the arteries.
Age: The risk of PVD increases significantly with age, particularly after 50.
Obesity: Being overweight or obese increases the risk of high blood pressure, high cholesterol, and diabetes, all of which are major risk factors for PVD.
Physical inactivity: A sedentary lifestyle contributes to obesity, high blood pressure, and high cholesterol. Regular physical activity can help manage these risk factors.
Family history: A family history of PAD, heart disease, or stroke suggests a genetic predisposition to atherosclerosis.
Kidney disease: Chronic kidney disease is often associated with a higher risk of cardiovascular diseases, including PVD.
High homocysteine levels: This is a less common risk factor, but elevated levels of this amino acid can damage artery walls.

Peripheral vascular disease screening and diagnosis

If you fall into any of the high-risk categories, or if you experience any symptoms related to leg discomfort during activity or non-healing sores on your feet, you should be particularly concerned and discuss screening and preventive strategies with your health care provider.

Screening and diagnosing PVD can involve a combination of patient history, physical examination, and various diagnostic tests. Since PAD is the most common and clinically significant form of PVD concerning arterial health, many methods are specifically geared toward identifying arterial blockages. However, some general approaches apply to other forms of PVD as well. Screening can include:

Ankle-Brachial Index (ABI): This is the primary and most important screening test for PAD. It compares the blood pressure in your ankle to the blood pressure in your arm. This is done by placing blood pressure cuffs on your arm and ankles. A Doppler ultrasound device is used to listen to the blood flow. A lower ABI (typically less than 0.90) indicates narrowed arteries in the legs.
Duplex Ultrasound (Vascular Ultrasound): The ultrasound uses sound waves to create images of blood vessels and measure blood flow. It can identify the location and severity of blockages, assess the speed of blood flow, and detect blood clots (useful for venous PVD too). It's very good for visualizing arterial narrowing or venous insufficiency.
Treadmill Test (Exercise ABI): If a resting ABI is normal but symptoms suggest PAD (e.g., claudication), an ABI can be remeasured after walking on a treadmill. Exercise can reveal blockages that aren't apparent at rest, as the demand for blood flow increases. A drop in ABI after exercise indicates PAD.
Toe-Brachial Index (TBI): Similar to ABI, but this test measures blood pressure in the big toe. It’s useful when arteries in the ankles are calcified (common in diabetics or those with kidney disease), making ABI unreliable.
Segmental Pressure Measurements: This test helps pinpoint the exact location of blockages by identifying pressure drops between segments. It’s done by placing blood pressure cuffs at various levels along the leg (e.g., thigh, calf, ankle) and compared.

Sometimes more in-depth testing is needed. When your doctor determines this is the case, they perform:

Angiography (Arteriography): A traditional X-ray procedure where a contrast dye is injected into an artery, and X-ray images are taken to visualize blood flow and pinpoint blockages. The angiography provides a detailed overview of the arteries, essential for surgical planning or interventional procedures like angioplasty.
Computed Tomography Angiography (CTA): This provides 3D images of arteries, showing calcification and blockages without needing a catheter to be threaded through the vessel. Using a CT scanner and injected contrast dye detailed cross-sectional images of blood vessels are shown so your doctor can view any blockages.
Magnetic Resonance Angiography (MRA): This test is similar to CTA but does not use X-rays, so it’s an alternative for patients who cannot have CT scans or prefer to avoid radiation.

Types of peripheral vascular disease

Understanding the type of PVD you have or are at risk for can help you navigate the potential side effects and treatment plan. Your AHN care team will talk with you about the specifics and how they will support you in treating your PVD.

Organic peripheral vascular disease (structural changes)

Organic PVD involves structural changes to the blood vessels, such as narrowing, blockages, weakening (aneurysms), or inflammation of the vessel walls. These changes are typically permanent or progressive without intervention.

Arterial organic PVD (diseases of the arteries):
- PAD due to atherosclerosis: The most prevalent form of PVD. Plaque buildup (atherosclerosis) physically narrows and hardens the arteries, primarily in the legs and sometimes arms.
- Aneurysmal disease (peripheral aneurysms): A permanent, localized bulging or dilation of an artery wall due to weakening of its structure. These can rupture or lead to clot formation.
Arterial Occlusive Disease (Non-Atherosclerotic):
- Fibromuscular dysplasia (FMD): Abnormal cellular development in artery walls causing stenosis (narrowing) or aneurysms, often affecting renal or carotid arteries.
- Traumatic arterial injury: Physical damage to an artery leading to rupture, dissection, or thrombosis.
- Peripheral arterial embolism/thrombosis (acute): Sudden blockage of an artery by a traveling clot (embolism) or local clot formation (thrombosis) without prior chronic narrowing.
Vasculitis/arteritis: Inflammation of the artery walls, leading to thickening, narrowing, or destruction of the vessels. This is a structural change at the microscopic level.

Diseases of the veins (venous organic PVD)

These conditions involve structural problems or physical blockages within the venous system, leading to impaired blood flow back to the heart including:

Deep vein thrombosis (DVT): Formation of a blood clot inside a deep vein, which physically obstructs blood flow.
Chronic venous insufficiency (CVI) varicose veins: Involves structural damage to venous valves, preventing proper blood flow back to the heart, leading to pooling and dilation of veins (varicose veins).
May-Thurner syndrome: An anatomical variant where the left common iliac vein is compressed by the right common iliac artery, leading to structural narrowing and increased risk of DVT.

Diseases of the lymphatics (lymphatic organic PVD)

These conditions involve structural problems or physical blockages/damage within the lymphatic system, leading to impaired drainage of lymph fluid.

Lymphedema: Swelling caused by a physical obstruction or damage to the lymphatic system, preventing proper drainage of lymph fluid. Can be primary (congenital) or secondary (e.g., due to surgery, radiation, infection).

Functional peripheral vascular disease

Functional PVD involves no physical damage or structural abnormality to the blood vessels themselves. Instead, it refers to conditions where the blood vessels undergo abnormal constriction (spasm) in response to certain triggers, temporarily restricting blood flow.

Arterial functional PVD

These conditions cause the arteries, though structurally normal, to exhibit abnormal and temporary constriction (vasospasm) in response to certain triggers. This spasm temporarily restricts blood flow, causing symptoms, but there is no underlying physical blockage, plaque buildup, or damage to the vessel wall itself.

Raynaud's phenomenon/disease: Episodic vasospasm (narrowing) of small arteries and arterioles, most commonly in the fingers and toes, in response to cold temperatures or emotional stress. The vessels themselves are normal in structure. The difference between disease and phenomenon is:
- Raynaud's Disease (Primary Raynaud's): Occurs without an underlying medical condition.
- Raynaud's Phenomenon (Secondary Raynaud's): Associated with an underlying condition (e.g., scleroderma, lupus, carpal tunnel syndrome).
Acrocyanosis: Persistent, painless, bluish discoloration of the hands and feet due to small blood vessel constriction, often in response to cold. Differs from Raynaud's in that it's continuous and usually symmetrical.

Peripheral vascular disease treatment

Peripheral vascular disease (PVD) and peripheral artery disease (PAD) can be treated in several ways, depending on the severity of the condition, your overall health, and the specific vessels affected. The primary goals of treatment are to reduce symptoms, improve quality of life, and prevent complications like heart attack, stroke, and limb loss.

Lifestyle changes

Often the first step, lifestyle changes are one of the most effective ways to help slow disease progression, reduce symptoms, and improve overall health without invasive interventions. Lifestyle changes often include:

Smoking cessation: This is the single most important lifestyle change for individuals with PAD. Smoking significantly worsens the disease.
Regular exercise: A structured exercise program, often supervised (known as "supervised exercise therapy"), is highly effective in improving walking distance and reducing symptoms. This typically involves walking until near maximal pain, resting, and repeating.
Healthy diet: A diet low in saturated and trans fats, cholesterol, and sodium can help manage blood pressure and cholesterol levels.
Weight management: Losing excess weight can reduce the strain on the cardiovascular system.
Diabetes management: Tightly controlling blood sugar levels is crucial for individuals with diabetes, as diabetes significantly increases the risk and severity of PAD.

Medications

Various drugs, including antiplatelets, statins, and blood pressure medications, are prescribed to manage PAD and its risk factors. These can effectively improve blood flow, prevent blood clots, control cholesterol, and manage blood pressure, helping to reduce the risk of serious complications and alleviate symptoms. The medications that may be prescribed include:

Aspirin: Often prescribed to reduce the risk of blood clots.
Clopidogrel (Plavix): Another antiplatelet drug that may be used, especially if aspirin is not tolerated or if the risk of clotting is high.
Cholesterol-lowering medications (statins): These help reduce LDL ("bad") cholesterol, which can slow the progression of atherosclerosis (hardening of the arteries).
Blood pressure medications: To manage hypertension, which is a major risk factor for PAD.
Medications to control blood sugar: For individuals with diabetes.
Cilostazol (Pletal): This medication helps improve walking distance by widening the arteries and reducing blood clotting. It's often prescribed for intermittent claudication (leg pain with exercise).
Pentoxifylline: While less commonly used than cilostazol, it can sometimes be prescribed to improve blood flow.

Endovascular procedures

These minimally invasive techniques, such as angioplasty and stenting, involve using catheters to open blocked or narrowed arteries. They offer a less invasive approach than traditional surgery, often with quicker recovery times, to restore blood flow and reduce symptoms. Procedure options may include:

Angioplasty: A balloon-tipped catheter is inflated inside the narrowed artery to open it up and improve blood flow.
Stent placement: After angioplasty, a small mesh tube called a stent may be placed in the artery to keep it open. Some stents are coated with medication (drug-eluting stents) to prevent renarrowing.
Atherectomy: A catheter with a specialized blade or laser is used to remove plaque buildup from the inside of the artery.

Surgical Procedures

For more severe blockages or when other treatments aren't sufficient, surgical options like bypass surgery are performed. These procedures create new pathways for blood flow or remove plaque, providing a durable solution to restore circulation and prevent limb-threatening complications. Your surgeon may perform:

Bypass surgery: A healthy blood vessel (either from another part of the patient's body or a synthetic graft) is used to create a new path for blood to flow around a blocked or narrowed artery.
Endarterectomy: The plaque buildup is surgically removed from the inside of the artery.
Rehabilitation: Post-procedure rehabilitation can help improve recovery and function.

The choice of treatment will always be individualized based on a thorough medical evaluation.

Peripheral vascular disease FAQs

Questions about peripheral vascular disease and peripheral artery disease are quite common. The similarities between the two can create confusion, and having clarity about the diseases is critical to your overall health. Your AHN care team is here to help answer your questions and give you specific answers so you can begin your treatment with confidence. We’ve also included some of our patients’ most frequently asked questions that may help guide your conversations with your care team.

What are the causes of peripheral vascular disease?

The primary cause of peripheral vascular disease (PVD), more accurately referred to as peripheral artery disease (PAD), is atherosclerosis. This is a condition where plaque (a sticky substance made of fat, cholesterol, calcium, and other substances) builds up inside the arteries, narrowing them and reducing blood flow. Risk factors that accelerate atherosclerosis include smoking, diabetes, high blood pressure, high cholesterol, obesity, age, and a family history of heart disease.

Does peripheral vascular disease affect the heart?

Yes, peripheral vascular disease (PVD)/PAD significantly affects the heart indirectly. PAD is a strong indicator of widespread atherosclerosis throughout the body, meaning that if plaque has built up in the leg arteries, it's very likely also present in the coronary arteries (leading to heart disease) and carotid arteries (leading to stroke). Therefore, individuals with PAD have a much higher risk of heart attack and stroke.

What is the prognosis for peripheral vascular disease?

The prognosis for peripheral vascular disease (PVD)/PAD varies widely depending on its severity, how well it's managed, and the presence of other health conditions. With early diagnosis, aggressive lifestyle modifications (especially quitting smoking and exercising regularly), and appropriate medical treatment, many people can manage their symptoms, prevent complications, and maintain a good quality of life. However, untreated or severe PAD can lead to critical limb ischemia, increasing the risk of amputation, and also significantly raises the risk of heart attack and stroke.

Is peripheral vascular disease reversible?

While the underlying atherosclerosis (plaque buildup) that causes peripheral vascular disease (PVD)/PAD is generally not fully reversible, its progression can be significantly slowed, and symptoms can be greatly improved. Intensive lifestyle changes, such as quitting smoking, exercising, and managing risk factors like high blood pressure and cholesterol, can halt further plaque buildup and even improve the function of the blood vessels. Medications and procedures can also effectively manage symptoms and prevent the disease from worsening.

What is the difference between peripheral vascular disease and peripheral artery disease?

Historically, peripheral vascular disease (PVD) was a broader term that included conditions affecting any blood vessels outside of the heart and brain, including veins and lymphatic vessels. However, in common clinical practice today, when people refer to PVD, they almost always mean peripheral artery disease (PAD), which specifically refers to the narrowing of arteries outside of the heart and brain, most commonly in the legs. Therefore, while PVD can technically encompass more, the terms are largely used interchangeably to describe blockages in the arteries of the limbs, predominantly the legs.

Contact us

If you have not been formally diagnosed, call (412) DOCTORS or 412-362-8677 to see your primary care provider to explore all possible causes of your symptoms. Depending on your symptoms, they can determine if you need to see a general cardiologist for further evaluation. To schedule an appointment with a vascular surgeon and be evaluated if a procedure is right for you, please call 412-359-8820.

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