Peripheral Vascular Disease: Understanding the Causes, Symptoms, and Treatment Options
Peripheral vascular disease affects blood circulation, especially in the legs and feet. Peripheral vascular disease (PVD) is a collective term for a plethora of disorders that affect blood vessels other than those of the heart. It is applied to the functional and structural changes that develop outside the heart and often result in ischemic complications. It encompasses arteries and veins from the large aorta to the smallest cutaneous venules. Sudden obstructions account for acute ischemic phenomena. A chronic state of reduction in arterial blood flow and oxygen delivery is the hallmark of cases that present diagnostic challenges. Both arteries and veins are involved, and such associations are not infrequent. The term “hardening of the arteries” simply refers to atherosclerotic changes that predominantly affect the intima and media of arteries and produce irregularly thickened vessels with hardened walls. Patients with clinically significant peripheral arterial occlusive disease (PAOD) are usually aware of their leg discomfort, as they often become symptomatic. It also heralds the presence of coronary and cerebrovascular occlusive diseases. The risk factors and the natural history of the three entities are the same. Symptoms of PAD in its most common form manifest themselves as limb discomfort with walking. However, 75% to 89% of affected individuals are asymptomatic, 10% to 25% have intermittent claudication, 1% to 2% have rest pain, and 1% to 3% have tissue loss usually involving ulceration, gangrene (wet) or dry gangrenes. A few develop critical limb ischemia, including cases where amputation is mandatory.
Peripheral arterial symptoms include intermittent claudication, rest pain, and ischemic ulcers. Most patients with PAD are asymptomatic. Symptoms of intermittent claudication occur in 2% to 7% of the general population, and up to 20% of people aged 70 or older have experienced intermittent claudication. Claudication should be differentiated from neurogenic claudication, which results from lower extremity compression with posture-induced changes in the spinal canal. Ischemic rest pain is a later stage of PAD and results from inadequate tissue perfusion. Rest pain is reproducibly relieved by placing the foot in the dependent position. This typically occurs while the patient is seated or while in bed at night and disrupts sleep. Pain clearing within 10 minutes after the dependent position is assumed is positive evidence for arterial occlusive disease. In the late stages of PAD, arterial stenoses and tissue hypoxia are severe and continuous.
As a result, chronic tissue ischemia leads to tissue breakdown and ulceration. Areas most likely to ulcerate are regions of high mechanical pressure, such as in the metatarsal region, distal to the malleoli, and along the female inside ankle before and beyond the medial malleoli. Ulceration is usually painless, and the pain developing from a previously painless ulcer is due to infection of the ulcer with abscess formation and cellulitis, occurring as a result of the underlying continuous arterial hypoperfusion. PVD-related ulcers induce essential patient management. Pain is typically greatest at night when the body’s own analgesics predominate. Symptoms of acute arterial thrombosis secondary to plaque rupture occur when ulcer infections disseminate from the foot to the calf muscle. The ulcer appears dry and leathery if it is inflamed but vital. Immediate vascular consultation is necessary, and surgical revascularization with or without limb-saving procedures may be required.
Definition and Overview
Peripheral artery disease is a condition where arteries narrow, reducing blood flow to the limbs. Peripheral vascular disease is the medical term for diseases of the blood vessels located outside the heart and brain. Many things contribute to the development of these diseases. The diseases themselves are diverse, and each one has different symptoms and treatments. Peripheral vascular disease includes a set of diseases in which blood vessel narrowing reduces the blood supply to the brain, intestines, liver, muscles, or kidneys. These diseases of blood vessels are sometimes called peripheral artery disease. Patients with nerve issues, such as diabetes, may not feel the pain of impaired healing that often comes from the decreased blood supply to the body tissue (usually in the legs, but can also occur in the gut wall, muscles, kidneys, and liver).
Peripheral vascular disease is not a single condition, but a set of diseases with many different causes and with many different symptoms. The symptoms depend on which blood vessels are involved. Patients might have chronic pain, particularly when they walk. The pain is called claudication. The pain due to claudication sometimes gets better when the patient is just resting their body, but in some cases, can be so severe that it interferes with the patient’s ability to work or do anything else. Some patients with peripheral vascular disease will develop wounds or ulcers that do not heal. Some will have discolored feet or muscle weakness. Some will have nausea or pain in their belly at the time that they exert themselves but will feel better right afterward. There is not a screening tool for peripheral vascular disease.
Symptoms and Diagnosis of Peripheral Vascular Disease
Peripheral arterial disease treatment may include lifestyle changes, medication, or surgery. The classic symptoms of more advanced peripheral vascular disease are cramping or tiredness in the legs or buttocks, which happens when you walk or exert yourself and is relieved when you rest. This discomfort—called intermittent claudication—is due to muscles needing more oxygen-rich blood during exercise. If a narrowed artery cannot deliver enough blood to an exercising muscle, the muscle will “cramp” and cause pain. Symptoms usually resolve within several minutes after you stop exercising, allow the leg muscles to “rest,” and the artery can supply the exercising muscles adequately. During this period of rest, the oxygen demand of the tired muscles decreases quickly, and the oxygen supply from the narrowed artery is again adequate.
People with peripheral vascular disease of the carotid arteries—or the arteries that supply blood to the brain—often do not have symptoms until they have had a stroke. Generalized peripheral vascular disease can result in symptoms due to decreased blood flow to some of the smaller arteries, most commonly in the feet. Decreased blood flow to the upper part of the body can be associated with high blood pressure, hypertension, or an increased risk of renal or kidney disease. Decreased blood flow to the intestines and abdominal organs may cause what is referred to as abdominal angina and can result in the patient experiencing pain immediately after eating. This can be another warning signal of significant peripheral vascular disease.
Treatment Options for Peripheral Vascular Disease
The treatment established depends upon the individual. A patient with peripheral vascular disease (PVD) may need a combination of medications and surgical interventions to manage and improve the circulation in their limbs.
Exercise – Engaging in a regular low-intensity exercise program increases circulation in the legs and improves muscle tone. The risk of needing surgical intervention is reduced with leg exercise since it is the primary location for claudication symptoms. In addition to exercise reducing the blood pressure, physical activity strengthens the heart as well.
Medications – High blood pressure, high cholesterol, blood clotting, and the narrowing of blood vessels are targeted with medication therapy. Nitroglycerin tablets, when placed under the tongue, will relieve claudication within approximately five minutes. Temporary relief can also be provided by limiting exercise and massaging the legs, taking a few slow deep breaths, or by bending at the waist with the windowsill touching the forehead. Drug treatment is similar to that for angina. Blood thinners will help reduce leg pain.
Medication to lower high atherosclerosis is narrowed blood vessels, thus reducing oxygen-carrying blood from the heart to organs and tissues over time. A proper diet, such as eating low-cholesterol, low-fat, and low-calorie foods, is an important part of a healthy lifestyle, along with regular exercise, that maintains. Low-dose aspirin, for its blood-thinning effect, can be beneficial, although it is imperative to discuss this with a doctor, as blood thinners may not be appropriate for everyone.
Lowering blood pressure is achieved through medications, diet, and exercise to prevent the hardening of arteries and further blood vessel damage. Severe hypertension must be managed under medical supervision. Statin drugs to lower cholesterol are the primary way to decrease harmful levels. It is imperative to stop smoking and manage diabetes to provide a comprehensive treatment plan. The patient’s doctor will introduce the most appropriate drug therapy.
Medication therapy is focused on limiting the deposit of plaque on blood-vessel walls, which narrows them. Carbohydrate and lipid management and modifying exercise strength can reduce claudication, although the efficacy of this approach has not been well documented. Such a lifestyle approach could also help with treating patients for risk factors such as elevated core temperatures which, in turn, promote plaque build-up in peripheral stent grafts.
Traditional Surgical Treatments
The following are the most common treatments for peripheral arterial disease. Surgical treatment has been known to be the most successful. However, the doctor will decide which treatment is best for you after considering your medical condition.
Bypass surgery is the most invasive approach to treat peripheral vascular disease. A vein or man-made blood vessel is used to bypass the blockage after making a small incision in your leg to create an alternate path for your blood flow to get around a blocked part of an artery.
Angioplasty procedure is used to open blocked arteries. A small balloon is placed at the end of a small hollow tube in surgery and threaded up to the site of the narrowed or blocked artery to force the blockage out of the way by pumping up the balloon. There is a new, less invasive surgery available, called balloon angioplasty.
Endarterectomy is a surgical intervention that is used to remove a fatty substance from a large artery in the groin. This is a non-invasive technique. After the fatty deposits are removed, the arterial wall will be smoothed out, eliminating the possibility that more deposits will be created.
Minimally Invasive Procedures at Vascular and Interventional Centre
Minimally invasive surgeries are procedures performed at the hospital’s Vascular and Interventional Centre. Many patients are treated using minimally invasive techniques such as angioplasty, stent placement, and the excision of damaged tissues. These procedures are performed using existing natural orifices or percutaneous (puncture) entry zones. This approach demands only a small incision, barely larger than a ball-point pen’s tip, and a shorter surgical duration to finish.
Medical treatment used for peripheral vascular diseases are other types of surgeries performed by closed procedures other than endovascular surgery. Thus, the medical treatment and open surgery would need the doctor to cut your chest and retract your sternum in order to gain access to your heart. With the advancement of medical sciences, however, more patients with heart diseases are choosing minimally invasive bypass surgeries because it is a less traumatic procedure with a shorter recovery period. With a catheter inserted into your blood vessel, the surgery involves the bypass of your blocked blood vessel without the reduction of flow between the ischemia or occlusive segment. It also only requires a small incision below the breasts, which limits blood loss, infection, and places less strain on your body. Since minimally invasive surgery is performed while under general anesthesia, you can rest assured that you will feel no pain and suffer no stress.
