Legs/Peripheral Vascular Disease

Peripheral vascular disease or PVD occurs when the arteries providing blood flow to the legs become narrowed or blocked by plaque buildup.  In the early stages walking becomes painful.  In later stages, pain and numbness may be present in the feet or toes at rest.  At its most severe, PVD may result in tissue breakdown causing ulcers or tissue death.  People with PVD symptoms often have plaque buildup elsewhere and have increased risk of heart attack and stroke.

The most common symptom of PVD is intermittent claudication which is a severe ache or weakness of the leg muscles brought on by walking a distance that remains fairly constant for the individual with PVD.  This ache is promptly relieved by a brief rest period after which he or she can walk about the same distance before the pain returns.  Sometimes the affected leg will feel cooler or have slower growth of nails or decreased hair.  Color change on the foot may occur.  In late stages there may be pain at rest within the foot or pain at night which interferes with sleep.  Slow healing wounds or development of sores on the leg or foot is also a symptom of advanced PVD.

Stenting

If your symptoms of PVD are severe or don’t respond to medical therapy your doctor may request diagnostic studies to determine the exact extent of your PVD.  In many cases the blockages can be opened in the affected artery by threading a balloon into the narrow or obstructed artery to dilate the affected area.  A stent is often placed in this area to keep the passageway open.

Surgery

If there is a long segment of diseased artery surgical bypass may be recommended.  Similar to a heart bypass, a vein is usually removed from the symptomatic limb and used to bypass the obstructed arterial segment.  With improvements in minimally invasive techniques such as covered stenting, cryoablation and atherectomy surgery is increasingly a last resort.

Medical Management

In most cases, peripheral vascular disease or PVD can be managed medically.  Optimal control of diabetes, cessation of cigarette smoking, controlling blood levels of cholesterol and exercise will improve symptoms in most patients with PVD.   In some cases medications designed specifically for PVD such as Cilostazol or Pentoxifylline may be prescribed.  Antiplatelet medication such as aspirin or Plavix may be prescribed to prevent sudden worsening of PVD.  Many people with PVD have undetected coronary or carotid disease and should be evaluated for these conditions.