Peripheral Vascular Disease


What is Peripheral Vascular Disease (PVD)?
What are the symptoms of PVD?
Who is at risk for PVD?
How is PVD diagnosed?
How can PVD be treated?
What can be done to treat PVD when lifestyle changes and medications are not enough?
How can I find out if I have PVD?
What is an interventional radiologist? 


Q. What is peripheral vascular disease? 
Ans. Peripheral vascular disease, or PVD, is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged, interfering with the normal flow of blood. The most common cause of PVD is atherosclerosis(often called hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that clogs the blood vessels. PVD may also be caused by blood clots.


Q. What are the symptoms of PVD?  
The disease, which affects both men and women, often goes undiagnosed and many people mistakenly think the symptoms are a normal part of aging. The most common symptom of PVD is painful cramping in the leg or hip, particularly when walking. This symptom, also known as "claudication", occurs when there is not enough blood flowing to the leg muscles during exercise. The pain typically goes away when the muscles are given rest.
Other symptoms may include numbness, tingling or weakness in the leg. In severe cases, you may experience a burning or aching pain in the feet or toes while resting, or develop a sore on the leg or foot that does not heal. People with PVD may also experience a cooling or color change in the skin of the legs or feet, or loss of hair on the legs. In extreme cases, untreated PVD can lead to gangrene, a serious condition that may require amputation of a leg or a foot.
If you have PVD, you are also at higher risk for heart disease and stroke

PVD Symptoms
Leg or hip pain during walking
The pain stops when you rest
Weakness in the legs
Burning or aching pain in feet or  
toes when resting     
Sore on leg or foot that won't heal
Cold legs or feet
Color change in skin of legs or feet
Loss of hair on legs



Q. Who is at risk for PVD?
Ans. As many as 10 million people in the U.S. may have PVD. Those who are at highest risk are:
over the age of 50,
people who do not exercise, or
people with high blood pressure or high cholesterol.
A family history of heart or vascular disease may also put you at higher risk for PVD.



Q. How is PVD diagnosed?
Ans. The most common test for PVD is the ankle-brachial index (ABI), a painless exam in which ultrasound is used to measure the ratio of blood pressure in the feet and arms. Based on the results of your ABI, as well as your symptoms and risk factors for PVD, the physician can decide if further tests are needed. PVD also can be diagnosed noninvasively with an imaging technique called magnetic resonance angiography (MRA), or with computed tomography (CT) angiography.  


  The ABI Test for PVD
  1. The ABI is a simple, painless test to help
  2. your physician determine if you have PVD.
  3. The blood pressure in your arms and
  4. ankles is checked using a regular blood
  5. pressure cuff and a special ultrasound
  6. stethoscope called a Doppler.
  7. The pressure in your foot is compared to
  8. the pressure in your arm to determine how
  9. well your blood is flowing and whether
  10. further tests are needed.


Q. How can PVD be treated?
Ans. The best treatment for PVD depends on a number of factors, including your overall health and the severity of the disease. In some cases, lifestyle changes are enough to halt the progression of PVD and manage the disease. Sometimes, prescription drugs or procedures that open up clogged blood vessels are used to treat PVD.
Lifestyle changes. Most treatment plans will include a low fat diet and a program of regular exercise. If you are a smoker, it is absolutely essential that you stop the use of all types of tobacco. If decreased blood flow to the legs is causing injury to the feet and toes, a foot care program to prevent sores or infection may be prescribed. This may include referral to a podiatrist.
Medication. Medications that lower cholestrol or control high blood pressure may be prescribed. New medications that help prevent blood clots or the build-up of plaque in the arteries, or that reduce the pain of PVD during exercise, also are available. 



Q. What can be done to treat PVD when lifestyle changes and medications are not enough?
Ans. There are a number of ways that physicians can open blood vessels at the site of blockages and restore normal blood flow. In many cases, these procedures can be performed without surgery using modern, interventional radiology techniques. Interventional radiologists are physicians who use tiny tubes called catheters and other miniaturized tools, and X-rays to do these procedures.
Procedures performed by interventional radiologists include:
angioplasty- a balloon is inflated to open the blood vessel.
thrombolytic therapy- clot-busting drugs are delivered to the site of blockages caused by blood clots.
stents- a tiny metal cylinder, or stent, is inserted in the clogged vessel to act like a scaffolding and hold it open.
stent-grafts - a stent is covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.
Sometimes, open surgery is required to remove blockages from arteries or to bypass the clogged area. These procedures are performed by vascular surgeons. 



Q. How can I find out if I have PVD?
Ans. If you suspect that you may have PVD, it is important that you see your personal physician for an evaluation.


Q.What is an interventional radiologist?
Ans. Interventional radiologists are physicians who have special training to diagnose and treat conditions using tiny, miniaturized tools while watching their progress on X-ray or other imaging equipment. Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for patients than surgery because they involve no surgical incision, less pain and shorter hospital stays. Your interventional radiologist will work closely with your primary care or other physician to be sure you receive the best possible care.

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