There is a lot of public awareness regarding heart attack and stroke. Lesser known may be the presentation of vascular disease other than the heart or brain, commonly referred to as peripheral vascular disease or PVD. Blood vessels may narrow, spasm or obstruct in arteries or veins. Often seen in legs, PVD commonly presents as pain and fatigue, especially during exercise, and may improve with rest. Arms and internal organs can be also be affected. A large percentage of this disease is specific to the arteries, known as peripheral artery disease, or PAD. Both terms commonly may refer to the same condition. According to the CDC, over 8.5 million people over 60 have PAD in the United States.
Two different situations occur to develop vascular blockage. Hardening of the arteries or atherosclerosis develops from plaques or blockages that slowly build up over time. As vessels slowly narrow, circulation is diminished. If the plaque ruptures or clots, there is an immediate and complete blockage of the vessel causing acute symptoms. When this occurs in the heart or brain, the result is a heart attack or stroke. With PVD, muscles demand higher oxygen during exertion, but the inability to provide adequate circulation results in pain and spasm. In some situations, a blood vessel that is otherwise undamaged may go into spasm and prevent circulation with similar outcomes. This can occur from exposure to cold temperatures, vibrating machines or tools, emotional stress or drugs that cause vessel spasm, such as some stimulants. There are diseases that greatly contribute to the development of PVD. Those individuals who have high blood pressure, high cholesterol and diabetes are at much greater risk of PVD. Smokers are at great risk as well from the damaging effects of smoking harming the blood vessels over time. Just the ageing process alone is a risk to those over sixty.
Common symptoms of PVD known as claudication may be the spasm, aches and fatigue of exertion, but sometimes may occur during sleep. Over time, there may be a noticeable reduction in the growth of hair on the legs. Thin or pale skin may develop as well, leading to the development of sores or ulcers that will not heal. Discoloration or blueish skin, especially fingers or toes may become evident. With continued diminishing blood flow, tissues may subsequently die leading to gangrene and amputation. An acute blockage results in significant pain along with a cold, pulseless and pale or blue skin. This is a medical emergency and needs immediate attention.
There are multiple ways to evaluate for PVD. Doppler ultrasound measures the sound waves from the blood flow in arteries and veins and can determine compromises. Ankle-brachial index, or ABI, compares the blood pressures of the upper and lower extremities. As blood pressures are generally consistent throughout the body, a difference between extremities can indicate PVD. Angiography injects contrast into the blood vessels and can visualize narrowing or obstruction in the arteries. Magnetic Resonance Angiography (MRA) or Computerized Tomography Angiography (CTA) are also radiology studies that image vessels to visualize disease.
The main goals of care are to stop the disease and manage the pain. Treatment may initially involve diet, increased exercise, weight loss and stop smoking. Management of underlying chronic disease is critical. There are various medications that may be appropriate as early treatment. In more severe cases, surgical intervention may be necessary to open and re-establish blood flow in the obstructed vessel. Early diagnosis is critical. Symptoms of PVD? Contact your primary care provider as soon as possible!
Bradford Croft, DO
East Flagstaff Family Medicine