Patient Education
Peripheral Vascular Disease/Stroke

About Peripheral Vascular Disease

Peripheral vascular disease is a general term for diseases of the blood vessels that carry blood to the arms, stomach, kidneys or legs. The term, often referring to the narrowing of blood vessels, does not pertain to vessels in the heart or the brain. Peripheral vascular disease can be categorized into two types, functional and organic.

Functional peripheral vascular diseases are short-term effects, sometimes felt as spasms, and are not caused by structural changes in the blood vessels. Functional peripheral vascular disease can be caused by emotional stress, smoking, cold temperature or operating vibrating machinery, such as a jackhammer. Raynaud's disease, which affects blood flow to the extremities, including the fingers, toes, nose and ears, when the body is exposed to stress or temperature change, is an example of functional peripheral vascular disease.

Organic peripheral vascular diseases are caused by structural changes in the blood vessels, including damage to the tissue and inflammation. Buerger's disease, a chronic inflammation of the peripheral arteries and veins of the extremities, is one example of organic peripheral vascular disease.

About Peripheral Artery Disease (PAD)

Another example of organic peripheral vascular disease is peripheral artery disease (PAD), which is caused by fatty buildup that block normal blood flow in the inner linings of artery walls. PAD is similar to coronary artery disease and carotid artery disease, which involve blockages that restrict blood circulation. Most PAD blockages affect circulation to the arms, legs, feet, kidneys and stomach. In the early stages of PAD, common symptoms include cramping or fatigue in the legs and buttocks during physical activity, which subsides during rest. This cramping is called "intermittent claudication". Often, those who have peripheral artery disease also have fatty buildup in the arteries of the heart and brain, which increases chances of death from heart attack and stroke.

Diagnosis and Treatment

PAD is diagnosed by reviewing a patient's medical history, performing a physical examination, and tests that include ultrasound, x-ray angiography and magnetic resonance imaging angiography (MRA).

PAD can be treated by lifestyle changes, including:

• Diet that includes low saturated-fat and low cholesterol foods.
• Exercise and physical activity (medically-supervised exercise program).
• Controlling diabetes and blood pressure.
• If a smoker, stop smoking.

PAD can also be treated using medications, including:

• Medications that help increase walking distance (cilostazol and pentoxifylline).
• Antiplatelet agents.
• Cholesterol-lowering agents (statins).

If PAD cannot be treated by lifestyle changes or medications, angioplasty or surgery may be necessary.

Angioplasty is a non-surgical procedure that widens a narrow or obstructed blood vessel using a balloon catheter. It is used to treat atherosclerosis (blood vessel obstructions), and usually performed by an interventional cardiologist, a medical doctor with special training in the treatment of the heart, using invasive catheter-based procedures.

Angioplasty is commonly performed as a minimally-invasive (percutaneous) procedure, where a stent (small mesh tube) is inserted into the blood vessel to keep it open. Performed in the cardiac catherization laboratory, the stent is place by the cardiologist using x-ray guidance. The stent procedure is done with local anesthesia and mild sedation.

If the blocked portion of the artery is long, surgery may be necessary. A vein from another part of the body is harvested, or a synthetic blood vessel is used. The vein or synthetic blood vessel is attached above and below the blocked area of the artery, making a detour around the blocked area.