Peripheral Vascular Disease
Peripheral Vascular Disease (PVD) is a term that refers to a collection of illnesses that occur due to blockages in arteries. When the disease occurs in the arteries to the legs, it is typically also called Peripheral Arterial Disease (PAD). The symptom that occurs due to the plaque in the arteries of the legs (resulting in “poor circulation”) is called Claudication, a cramping of the muscles that occurs with activity, and is relieved with rest. This is also known as “angina of the legs,” as it is caused by the same mechanism that causes chest pain from heart disease, or angina. Blockages in the arteries to the muscles of the legs limit the ability to increase blood flow to those muscles during exercise, with the result being pain. The risk factors for progressive narrowing of the arteries are increasing age, diabetes, high blood pressure, elevated cholesterol, and smoking.
It is estimated that between 8 and 12 million Americans have PAD, with many having no symptoms, due to the fact that the blockages are not yet severe enough. As the plaque worsens, symptoms appear. Vascular surgeons typically divide patients with PAD into several categories: non-disabling claudication, lifestyle limiting claudication, and limb threatening disease. The decision to treat at all is individualized, depending on the patient, and their severity of disease. The type of treatment is also always individualized, based on the extent and distribution of disease, and the severity of the patients’ symptoms.
Treatment of Peripheral Arterial Disease
It is important to recognize that most patients with PAD remain stable in reference to their leg symptoms. PAD however is a significant marker for heart disease. If you have PAD, whether symptomatic or not, your life expectancy is shortened. It is very important to remember that it is not normal to have leg pain merely because one is getting older.
The medical treatment of PAD is basically an attempt to halt the progression of disease (by risk factor modification) and to create a healthier life style in general. The hallmarks of conservative or medical therapy are exercise, blood pressure control, the stopping of smoking and the improvement in cholesterol levels and patterns. Some of the medications used are platelet inhibitors (aspirin and Plavix) to help prevent clotting along plaques, and statins to lower cholesterol. Currently, Cilostozol (Pletal) is the only medication that will improve walking distance.
When leg symptoms are disabling or lifestyle threatening, and medical therapy is either inappropriate or has been ineffective, the treatment needs to be more involved and aggressive. If the diagnostic arteriogram (x-Rays) demonstrates focal (non-diffuse) blockages of the arteries, then a balloon angioplasty/stent procedure can be considered. If the blockages however are complete or in multiple areas, then a surgical bypass must be done to improve blood flow.
In the most severe category of disease, limb threat, a bypass is typically required, and angioplasty is only rarely considered to be either appropriate or sufficient. Limb threat is defined as the presence of gangrene, a non-healing wound, or pain at rest in the foot. The limb will be lost if successful reconstruction is not accomplished.
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