What is peripheral vascular disease?

Peripheral vascular disease (PVD, also known as 'peripheral artery disease') refers to diseases of arteries outside the heart and brain.

The build-up of atheroma (fatty deposits on the walls of the arteries) makes the arteries narrower and restricts the flow of blood to the part of the body affected. This process is called 'atherosclerosis'. PVD mainly affects the arteries leading to the legs and feet.

If you have PVD, you are at greater risk of coronary heart disease or a stroke.

What are the symptoms of peripheral vascular disease?

The most common symptom of PVD in the abdomen and legs is painful cramping in your leg muscles triggered by physical activity such as walking or climbing the stairs.

The pain usually develops in your calves, but sometimes your hips or thigh muscles can be affected. It can range from mild to severe. The pain will usually go away after 5 to 10 minutes when you rest your legs. This pattern of symptoms is known as 'intermittent claudication' (claudication is a Latin term that loosely translates as 'limping').

Other symptoms of PVD in the abdomen and legs may include:

• hair loss on your legs and feet
• slower growth of your toenails
• numbness or weakness in the legs
• coldness in your lower leg or foot
• a change in the colour of your leg
• brittle, slow-growing toenails
• ulcers (open sores) on your feet and legs, which do not heal
• changing skin colour on your legs, turning pale or bluish
• shiny skin on the legs
• wasting of the muscles in your legs
• you or your doctor is unable to feel a pulse in your leg or the pulse feels much weaker than normal
• men may develop impotence (erectile dysfunction)

What causes peripheral vascular disease?

There are many factors that can dangerously speed up the narrowing of your arteries such as:

• smoking
• having poorly controlled diabetes
• eating a high-fat diet
• having high cholesterol
• high blood pressure

When should I see my doctor?

Many people mistakenly think that recurring episodes of leg pain are part of growing older, but this is not true. There is no reason why a healthy person should experience leg pain.

If you do experience recurring episodes of leg pain especially when walking that then resolves on rest, make an appointment with your doctor, especially if you are a smoker, you have diabetes, or you have high blood pressure and/or high cholesterol.

When to seek urgent medical advice

Some symptoms may suggest that the supply of blood to your legs has become severely restricted and you may need to see a doctor urgently. These include:

• being unable to move the muscles in the affected leg
• feeling a burning or prickling sensation in the affected leg
• your toes suddenly turn blue
• the skin on your toes or lower limbs becomes cold and numb, and turns reddish and then black or begins to swell and produce foul-smelling pus, causing severe pain

How is peripheral vascular disease diagnosed?

If your doctor suspects you have peripheral vascular disease, they will usually carry out a physical examination of your leg.

They may compare the blood pressure in your leg to the blood pressure in your arm by using a test called the ankle brachial index (ABI).

In most cases, your doctor will be able to confirm a diagnosis of PVD by doing a physical examination, asking about your symptoms and checking your ABI score. They may also order an ultrasound to look at the blood flow, angiography (where dye is injected into your blood vessels so the doctor can watch the flow of blood using various imaging techniques), or blood tests. They will often refer you to a specialist.

How is peripheral vascular disease managed?

There are 2 main types of treatment used in the management of PVD.

• Making lifestyle changes can improve symptoms and reduce your risk of developing a more serious cardiovascular disease (CVD), such as coronary heart disease. If you smoke, then try to stop. Doing regular exercise helps to reduce the severity and frequency of PVD symptoms, while at the same time reducing the risk of developing another cardiovascular disease. The best exercise for people with PVD is walking. Try to build up to at least 30 minutes.
• Taking medication will address the underlying cause of PVD and reduce your risk of developing another cardiovascular disease. For example, a statin can be used to lower your cholesterol levels or an antihypertensive can treat high blood pressure. You will probably be recommended to take low-dose aspirin.

Surgery may be used as a last resort. This may involve a bypass graft if the blood flow in your leg is obstructed. Another possible procedure is angioplasty and stenting to unblock an artery and keep it open.

Can peripheral vascular disease be prevented?

You can help to prevent PVD by making sure your diabetes is controlled and keeping your blood pressure and blood cholesterol at healthy levels.

Make healthy food choices and exercise regularly, at least 30 minutes on most days of the week.

If you are overweight, losing even a small about of weight will reduce your risk.

If you smoke, you should try and quit.

Complications of peripheral vascular disease

Severe cases of PVD can lead to limb ischaemia (lacking blood supply), when blood flow to the limbs is severely restricted by fatty deposits on artery walls. It is very serious.

Symptoms include:

• A severe burning pain in your legs and feet even when you are resting; the pain often occurs at night and episodes of pain can last several hours.
• Your skin turns pale, shiny, smooth and dry.
• You have wounds and ulcers (open sores) in your feet and legs that show no sign of healing.
• The muscles in your legs begin to waste away.
• The skin on your toes or lower limbs become cold and numb and turns reddish and then black or begins to swell and produce foul-smelling pus, causing severe pain.

If you think you are developing the symptoms of limb ischaemia, contact your doctor immediately.

The cause of your PVD can also affect the arteries supplying blood to your heart and brain. If you have the condition, you're more likely to have angina, a heart attack, a stroke or coronary heart disease.