Peripheral Vascular Disease

Vascular disease is disease of the blood vessels (arteries and veins). A common and serious form of vascular disease (coronary artery disease) affects the arteries that give oxygen to the heart muscle. Peripheral vascular disease (PVD) affects the areas that are “peripheral,” or outside your heart. The most common types of PVD are:

• Carotid artery disease affects the arteries that carry blood to your brain. It happens when one or more arteries are narrowed or blocked by plaque, a fatty substance that builds up inside artery walls. Carotid artery disease can increase your risk of stroke. It can also cause transient ischemic attacks (TIAs) — temporary changes in brain function that are sometimes called “mini-strokes.”
• Peripheral arterial disease (PAD) often affects the arteries to your legs and feet. It is also caused by plaque buildup.
• Deep vein thrombosis (DVT) affects the veins, usually in your legs or feet. A clot (thrombosis) forms inside the vein. The clot can break free and travel to your lungs, where it can cause serious illness or even death.
• Venous insufficiency affects the veins, usually in your legs or feet. Your veins have valves that keep blood from flowing backward as it moves toward your heart. If the valves stop working, blood backs up in your body, usually in your legs.

Most people who get PVD don’t have symptoms, although some people who have PAD may feel cramping or pain in the legs or buttocks during and after exercise. This is called claudication. Other symptoms include:

• Wounds that don’t heal or health slowly
• A foot that feels cold in comparison to the other hand or foot
• Numbness in the leg or foot
• Pale skin
• Thick toenails, or slow toenail and hair growth on the feet

Venous insufficiency can cause:

• Pain and swelling in the legs, ankles, and feet
• Discolored skin
• Leg sores
• Varicose (enlarged, visible) veins

Symptoms of PVD may be similar to other health conditions. See your healthcare provider for an accurate diagnosis.

You are more at risk for PVD if you:

• Smoke
• Are overweight
• Don’t exercise
• Have high blood pressure
• Have a family history of PVD, heart disease, or stroke
• Are over 50 years old

You have a higher risk for artery problems if you have diabetes and high blood cholesterol. You have a higher risk for vein problems if you stand or sit for long periods of time.

The two most common tests for PVD are described below. Generally, you don’t need to prepare beforehand, and they usually take less than an hour. You’ll get the results in a follow-up appointment.

Ankle-brachial index (ABI) test

An ABI test compares the blood pressure in your ankle and your arm. Here’s what happens during an ABI test:

• Getting ready. You’ll change into a gown and lie down on an exam table.
• Blood pressure cuffs. A technician will place blood pressure cuffs on your arms and ankles and inflate the cuffs.
• Ultrasound. As the cuffs deflate, a technician will hold an ultrasound device called a transducer against each ankle and arm. The device uses high-frequency sound waves to measure the blood pressure in each area.
• Ratio. The ankle blood pressures will be divided by the highest arm pressure to create an ABI ratio. A ratio lower than normal means you probably have PAD.
• Treadmill exercise, then a second measurement (optional). Depending on your situation, you might exercise on a treadmill. You will then have another ABI test.

Doppler Ultrasound

A Doppler ultrasound test uses high-frequency sound waves to evaluate the flow of blood in your blood vessels. Doppler ultrasound can be used to evaluate blood vessels in your legs, neck, or abdomen. Here’s what happens during a Doppler ultrasound test:

• Getting ready. You’ll change into a gown and lie down on an exam table.
• Gel. Depending on the area being studied, a technician will put water-based gel on segments of your legs or on your neck.
• Ultrasound. A Doppler ultrasound device, called a transducer, will be moved along your skin in the area that is being studied. The transducer uses high-velocity sound waves to evaluate the blood flow through your blood vessels. The test can show narrowed blood vessels, blood clots, or areas where the blood is flowing backward.
• Cleaning up. At the end of the test, the technician will wipe off the ultrasound gel so that you can dress to go home.

Other Tests

• Angiogram
• Magnetic resonance angiography (MRA)
• CT Angiography
• Venography

Your doctor will discuss your treatment options with you. Possible treatments for vascular disease include:

• Lifestyle changes. You can control many of the factors that cause PVD by making the following changes in your daily routine:
• Quit smoking. This is the single most important thing you can do for your health. Ask your healthcare provider for a copy of Intermountain’s Quitting Tobacco: Your Journey to Freedom booklet.
• Lose weight. Intermountain’s Weight to Health program can help. Ask your healthcare provider how to sign up.
• Exercise. Movement will help you lose weight, lower your cholesterol and blood pressure, and strengthen your heart. It will also help you feel better mentally and emotionally.
• Manage your diabetes, if you have it. Set a realistic glucose target with your healthcare provider and stick to it.
• Lower your cholesterol. Eat a health diet, exercise, and take your prescription medicines.
• Medicine. You might receive medicine to help control your cholesterol or blood pressure, help your body remove extra fluid, keep your blood from clotting easily, or help clear your arteries.
• Compression stockings. Special stockings, sometimes called T.E.D. hose, squeeze your lower legs to help keep the blood flowing.
• Catheter-based treatments. A catheter (a thin, flexible tube) may be inserted through your skin into a major blood vessel and threaded to the area that needs treatment. The catheter contains an empty balloon that is then inflated to compress the plaque and open up the artery. A stent, a wire mesh support, can also be inserted to help prop open an artery.
• Surgery. Surgery might be used to remove faulty veins, repair vein valves, bypass a section of blocked artery, or clean out plaque buildup.

Some risk factors for PVD can’t be changed, such as your family history or your age. But you can control or eliminate other risk factors, such as the lifestyle changes listed above. Taking action can help prevent vascular disease or keep it from getting worse.

• National Heart, Lung, and Blood Institute
• American Heart Association
• Medline Plus