Introduction
Peripheral arterial disease (PVD), also known as atherosclerosis or hardening of the arteries, is a buildup of plaque inside arteries which then reduces blood flow. It may affect any artery in the body and is very common in the arteries of the leg. If too much plaque builds up a severe restriction to the blood flow may occur. This lack of blood flow can cause difficulties walking, foot pain, ulceration or limb threatening tissue necrosis in severe cases.
Causes
Peripheral arterial disease is associated with a number of lifestyle and inherited risk factors.
These Include:
- Smoking.
- Diabetes.
- High cholesterol.
- High blood pressure.
- Sedentary lifestyle.
- Family history (genetics).
- Older age.
Symptoms
The symptoms produced by peripheral arterial disease vary depending on the severity and location of the plaque build-up.
Symptoms include:
- Muscle pain with walking (claudication) – most commonly in the calves, but also the thighs and buttock muscles.
- Loss of sensation.
- Foot pain (especially at night).
- Pale feet.
- Cold feet.
- Loss of hair from lower legs.
- Poor wound healing.
- Ulcers.
- Recurrent infections.
- Gangrene.
Tests
The diagnosis of peripheral arterial disease is made based on the history of symptoms and other medical conditions, physical examination (particularly assessment of peripheral pulses), ultrasound, CT scan and MRI scan.
Which investigation is required depends on the severity of symptoms and need for treatment.
Diagnosis
The diagnosis of peripheral arterial disease is usually made by physical examination and confirmed with appropriate imaging. Imaging helps confirm the diagnosis and also assess treatment options.
Treatment
Treatment of peripheral arterial disease is based on 2 areas. Firstly, controlling the medical conditions that predispose and aggravate PVD. Secondly, treating the consequences of a lack of blood flow.
Medical treatment involves smoking cessation, treating diabetes, high blood pressure, high cholesterol and using blood thinners (e.g. aspirin).
Intervention for PVD depends on the severity of symptoms. If the symptoms are relatively mild (such as calf pain after walking 500m) then medical treatment plus an exercise program will often improve the PVD. If symptoms are more severe, such as short distance walking, pain at night, ulceration or gangrene, then the blood flow needs to be improved. If this does not occur then there is a significant risk of limb loss (amputation) in severe situations.
There are a number of options to improve blood flow. These include:
- Angioplasty.
- Stenting.
- Endarterectomy (surgery for plaque removal and arterial repair).
- Bypass surgery.
Which option is appropriate will depend on the nature of the plaque, its location, type of symptoms and the fitness of the patient.
Related Information
Femoral Aneurysms
Popliteal Aneurysms
Arterial Bypass Surgery
Peripheral Artery Balloon Angioplasty
Peripheral artery Stenting
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