The perivascular disease is a disorder of the blood vessels present outside of the heart and brain. Read this article to know more.
Peripheral vascular disease or PVD is a disease of the blood vessels present outside of the heart and brain, especially the arteries of the legs, and is caused by the deposition of cholesterol and other fats. Other parts of the body getting affected are the arms, stomach, kidney, and intestines. Peripheral artery disease (PAD) is the most common form of PVD. This causes less blood to flow through the arteries and eventually decreases oxygen supply (ischemia), and causes symptoms from this reduced blood supply. A particular person suffering from perivascular disease may experience aggravated pain while exercising or vigorous movements.
There are two types of peripheral vascular diseases:
Functional Peripheral Vascular Disease - This type of peripheral vascular disease will not include any damage to the blood vessels. Rather the blood vessel will narrow or widen in response to certain factors like brain signals and temperature changes.
Organic Peripheral Vascular Disease - This type of peripheral vascular disease includes plaque accumulation, blood clots, and injury to the blood vessels.
Accumulation of fat deposits inside the arteries and forming a plaque is the main reason for peripheral vascular disease (PVD). This condition is known as atherosclerosis.
Presence of high blood sugar (diabetes) for a longer time will damage the blood vessels. If the same person has high blood pressure too, atherosclerosis will result.
Even the presence of blood clots can obstruct blood flow.
Blood vessels can get damaged due to infections like salmonella and syphilis.
Mental stress and extreme cold temperatures can cause functional peripheral vascular diseases.
Conditions like deep vein thrombosis, varicose veins, thrombophlebitis, and Raynaud’s phenomenon can also cause.
Depending on the severity of the disease, symptoms can be as follows:
Skin dryness, darkening and peeling.
Pain on walking or exercise. This is the most common sign of perivascular disease.
Pain even at rest.
Skin ulceration (wounds) over the toes or feet.
Large non-healing ulcers over the feet or legs.
High blood lipids or high cholesterol present for a long time, will increase the risk of peripheral vascular disease.
Diabetes or high blood sugar level.
If a person has a family history of stroke, diabetes, high cholesterol, and high blood pressure.
Smoking increases the risk of peripheral vascular disease.
Obese people are more likely to develop peripheral vascular disease.
People of African-American origin are more likely to develop peripheral vascular disease.
Peripheral vascular system has to be treated at the earlier stages, otherwise it may lead to various complications as follows.
Affected individuals may suffer from impotence or infertility.
The skin may become pale.
The affected individual may experience immense pain both while resting and moving. In some cases, the patient may not be able to move and mobility will be restricted.
In severe cases, the bone and the blood can get affected and result in life-threatening conditions.
The most severe complication includes the blockage of arteries that supply heart and brain. This may cause heart attack, stroke, or even death in the worst case.
Feeling for the leg pulses at various anatomical locations can help determine loss of blood supply to that leg.
A color Doppler ultrasound/a CT (computed tomography) or magnetic resonance angiogram can also be done to document blocks in the arteries of the feet. Angiography is done to find if there is any blockage in the vessel. It is done by injecting a dye into the artery through a catheter. MRI (magnetic resonance imaging) will be performed to detect blockages in the artery. Doppler ultrasound will help detect the blood flow.
Patients will be advised to undergo blood tests to detect conditions that may increase the severity of peripheral vascular disease, like diabetes, hypertension, and high cholesterol.
Mild disease can be treated by lifestyle modification and medications. Severe disease can be treated by angioplasty and stenting. This is done in a cath lab (catheterization laboratory) and is done via a small pinhole access in the groin. Small instruments like catheters and wires are used to reach the blocked artery and blocks are opened by inflating appropriately sized balloons across the blocks. Stents can also be placed to scaffold the treated segments and help the artery to remain open. Long segment occlusions can need surgical bypass graft placement.
Medications that the patient will be prescribed are as follows:
a) Aspirin and Clopidogrel - To prevent blood clotting.
b) Statins to reduce cholesterol levels.
c) Medications to reduce blood sugar levels.
Yes, unless the risk factors are eliminated, the disease can come back.
You still need to stay-off of all kinds of tobacco, have good blood pressure and diabetes control and continue to take your blood thinning medications.
Patients who go back to smoking after their symptoms reduce; invariably have a recurrence that needs to be treated.
Typically the patient gets admitted the day before the procedure, certain tests are done to determine the kidney and cardiac function. The procedure is done the next morning. Since the angioplasty is done via a small pin hole over the groin, there is very little down time. You can walk around 6 hours after the procedure and go home the next day.
Peripheral vascular disease (PVD) is a condition which can cause some serious life-threatening conditions. Lifestyle modifications, appropriate treatment with medication to control the underlying medical conditions and surgery to repair the damages can help the affected individual cope up.
The signs of vascular disease are:
- Pale or bluish skin.
- Lack of hair in the leg or toenail growth.
- Sores on feet, toes, or legs that heal slowly or do not heal.
- Decreased skin temperature, with thin, brittle, shiny skin on the feet and legs.
- Weak pulse in the legs and feet.
Peripheral vascular disease (PVD), if untreated, can lead to critical limb ischemia, a severe stage of PVD that can end up in the loss of the affected limb. But when it is diagnosed in the early stage, it is treatable and reversible. PVD can be reversed by following certain lifestyle changes like proper nutrition, regular exercise, and quitting smoking.
The following methods can help to diagnose peripheral vascular disease:
- Magnetic resonance angiography (MRA).
- Ankle-brachial index (ABI).
- Treadmill exercise test.
- Doppler ultrasound flow studies.
- Pulse volume recording (PVR) waveform analysis.
- Photoplethysmography (PPG).
- Reactive hyperemia test.
Vascular pain can occur as the result of interruption of the blood flow to the muscles or tissues. Vascular pain can be felt as pain or heaviness in certain areas where there is a lack of circulation. There can also be weakness, numbness, or a tingling sensation in the affected area.
The arteries usually bring blood to the heart and brain. In case of peripheral vascular disease, when this blood gets clogged, it will lead to stroke, heart attack, or death.
The main goal of the treatment of peripheral vascular disease is to control the symptoms and prevent further progression of the disease. Peripheral vascular disease can be treated by alteration in the lifestyle like proper nutrition, regular exercise, and quitting smoking, medication, surgery, and the combination of the treatment methods.
The stages of peripheral artery disease are:
- Stage 1 – Mild claudication.
- Stage 2 – Moderate claudication.
- Stage 3 – Severe claudication.
- Stage 4 – Rest pain.
The best drugs for peripheral vascular disease are:
- Antiplatelet agents like Aspirin or Clopidogrel.
- Cholesterol-lowering medications like statins like Atorvastatin and Simvastatin.
- Cilostazol increases the blood flow to the arteries and relieves symptoms of claudication.
- Pentoxifylline also improves the blood flow to the arteries and relieves symptoms of claudication.
- Angiotensin-converting enzyme (ACE) inhibitors to reduce high blood pressure.
The most common type of the peripheral vascular disease are:
- Myocardial infarction (MI).
- Peripheral arterial disease (PAD).
- Coronary artery disease (CAD).
The long term complication of peripheral vascular disease may include:
- Weakness in the lower-extremity with impaired functional status.
- Increased rate of functional decline.
- Infections in the extremities.
- Chronic skin ulceration.
- Sores that do not heal.
The severe form of peripheral vascular disease (PVD) is a condition where there is a narrowing of the blood vessels outside the heart that cannot deliver enough oxygen and nutrients to the body. If left untreated, PVD can cause chronic wounds on the limbs and increase heart attack or stroke risk.
Peripheral vascular disease (PVD) is a circulation disorder. There is no cure for PVD, but we can control symptoms and prevent the disease's progression by medications, alteration in the lifestyle, angioplasty, surgery, or treatment methods. The treatments can also help to reduce the risk of cardiovascular diseases like coronary artery disease and stroke. If not treated, it can lead to complications like pain, gangrene, infection of the extremities, ulcers, sores that do not heal, amputation, and death.
Last reviewed at:
18 Aug 2022 - 4 min read
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