Peripheral Vascular Disease Overview
Peripheral vascular disease results from a narrowing of the arteries in the legs and sometimes the arms, generally due to atherosclerosis, the buildup of plaque in the arterial walls. Plaque—composed of cholesterol-rich fatty deposits, collagen, other proteins, and excess smooth muscle cells—gradually accumulates in the arteries. Thickening of the arterial walls narrows the vascular channels and impedes blood flow. During walking or other activities the narrowed arteries are unable to supply enough blood and oxygen to the muscles, causing pain (intermittent claudication), most commonly in the calves.
Peripheral vascular disease is most common after the age of 50, although one form can affect some male smokers as early as age 20. Diabetes greatly increases the risk of peripheral vascular disease, especially in women. The disease may worsen if left untreated, in some cases even leading to tissue death (gangrene). Peripheral vascular disease shares the same risk factors as the more dangerous coronary artery disease, and the diseases often occur together.
What Causes Peripheral Vascular Disease?
- Atherosclerosis is the most common cause.
- Smoking is the greatest risk factor.
- Obesity, a sedentary lifestyle, high cholesterol levels, and high blood pressure contribute to atherosclerosis.
- People with diabetes mellitus are at increased risk.
Symptoms of Peripheral Vascular Disease
- Muscle pain in the calves or thighs of one or both legs that occurs when walking, especially fast or uphill. Pain subsides with rest. It may also occur in the fingers, arms, buttocks, lower back, or the arch of the foot.
- Impotence (erectile dysfunction)
- Ulceration or gangrene
- Uncontrolled hypertension (high blood pressure)
- Symptoms of severe disease: muscle pain at rest that worsens at night; discolored or blue toes; cold or numb feet; numbness in the affected area when at rest; sores on the feet or legs that do not heal; added sensitivity to cold, or weak or absent pulse in the affected limb; scaly or hairless skin over the affected area
Peripheral Vascular Disease Prevention
- Don’t smoke.
- Exercise regularly.
- Eat a diet low in saturated fat, cholesterol, and salt.
- Have your cholesterol and blood pressure checked (and treated if levels are elevated).
- Lose weight if overweight.
Peripheral Vascular Disease Diagnosis
- Patient history and physical examination.
- Angiogram detects blockage or narrowing of the vessels.
- Blood pressure measurements in the arms and legs.
- X-rays of the arteries after the injection of a contrast material (angiography).
- Ultrasound or MRI (magnetic resonance imaging).
- Treadmill exercise test may be performed to monitor the heart’s activity under stress.
How to Treat Peripheral Vascular Disease
- Follow prevention tips.
- Each day, take a walk and continue until leg pain develops. Rest for a short time to let the pain subside, then continue walking. Gradually, the distance that can be traveled painlessly will increase.
- Practice good foot care and check your feet every day. Poor circulation due to peripheral vascular disease slows the healing of sores. Spotting problems early may help to prevent minor foot problems from becoming major infections.
- Pentoxifylline (Trental), a blood-viscosity reducing agent, may be prescribed to improve blood flow.
- People with diabetes must maintain scrupulous control over their blood sugar levels.
- Daily doses of aspirin may be prescribed to prevent blood clots that can lead to heart attack or stroke.
- Cholesterol-lowering drugs may be prescribed for those with unhealthy blood cholesterol levels that cannot be controlled by lifestyle changes alone.
- In severe cases angioplasty to dilate the narrowed portion of the artery, or bypass surgery to reroute blood around the narrowed artery may be necessary.
- In extreme cases when gangrene is spreading uncontrollably, amputation of the affected limb may be required.
When to Call a Doctor
- Make an appointment with a doctor if you repeatedly develop muscle pain when walking or at rest.
Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference
Simeon Margolis, M.D., Ph.D., Medical Editor
Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50
Updated by Remedy Health Media