Questions and Answers about Peripheral Vascular Disease

17. What is peripheral vascular disease?

1. Peripheral vascular disease, or PVD, is a condition in which the arteries that  carry blood to the arms or legs become narrowed or clogged, slowing or stopping the flow of blood.

17. What are the symptoms of PVD?

1. The most common symptom of PVD is called intermittent claudication, a pain in the leg, particularly when walking.  Other symptoms may include numbness, tingling, and weakness in your leg.  In severe cases, patients may develop an ulcer, or sore, on the leg or foot that doesn’t heal.  If left untreated, ulcers can become infected.  In extreme cases, untreated PVD can lead to gangrene, a serous condition that may require amputation of the leg or foot.

17. What causes PVD and intermittent claudication?

1. PVD and intermittent claudication are caused by atherosclerosis, or hardening of the arteries.  Atherosclerosis is a gradual process in which cholesterol and scar tissue build up inside the artery, forming a substance called “plaque” that clogs the artery.  PVD symptoms also can develop when a blood clot forms in the artery.

17. Why does PVD occur?

1. It is not known for certain why PVD occurs.  Factors that contribute to the disease include smoking, high blood pressure, diabetes, high cholesterol, a family history of heart or vascular disease, or being overweight.

17. What can be done to stop the progression of PVD?

1. In some cases, PVD can be successfully controlled by certain lifestyle changes, such as exercise programs and dieting to lose weight and lower blood cholesterol.  The single most important thing you can do to slow PVD is stop smoking.

17. How is PVD treated?

1. When lifestyle changes alone are not enough to control the symptoms of PVD, there are a number of treatment options, including:

• Medication.  Medications that lower cholesterol or control high blood pressure may be prescribed.  Medication also is available that has been shown to significantly increase pain-free walking distance and total walking distance in people with intermittent claudication.  Other medications that help prevent blood clots or the build-up of plaque in the arteries are available, as well.
• Angioplasty.  In this procedure, an interventional radiologist inserts a very small balloon attached to a thin tube (catheter) into a blood vessel through a small nick in the skin.  The catheter is threaded under X-ray guidance to the site of the blocked artery.  The balloon is inflated to open the artery.  In some cases, a tiny metal cylinder, or stent, is left behind in the artery to keep it open.
• Thrombolytic therapy.  This treatment is used by an interventional radiologist if the blockage in the artery is caused by a blood clot.  Thrombolytic drugs—sometimes called clot-busting drugs—dissolve the clot and restore blood flow.  Usually, the drugs are administered through a catheter directly into the clot.  These drugs are frequently combined with another treatment, such as angioplasty.
• Bypass grafts.  In this procedure, a vein graft from another part of the body or graft made from artificial material is used to create a detour around the blocked artery.  Bypass grafts typically require surgery, but other ways of placing the grafts without major surgery are now being developed.
• Thrombectomy.    This procedure is used only when symptoms of PVD develop suddenly as the result of a blood clot.  In the technique, a balloon catheter is inserted into the affected artery beyond the clot.  The balloon is inflated and pulled back, bringing the clot with it.  Thrombectomy usually is performed as an open surgical procedure.

17. How do I know which treatment will be best for me?

1. Interventional radiologists are doctors who specialize in minimally invasive, targeted-treatments performed using imaging for guidance. They use their expertise in reading X-ray, ultrasound, MRI and other diagnostic imaging, to guide tiny instruments, such as catheters, through blood vessels or through the skin to treat diseases without surgery. Interventional radiologists are board-certified and fellowship trained in minimally invasive interventions using imaging guidance. The American Board of Medical Specialties certifies their specialized training.  Your interventional radiologist will work closely with your primary care or other physician to be sure you receive the best possible care.