Peripheral Vascular Disease
What is Peripheral Vascular Disease?
Peripheral vascular disease (PVD) is usually due to atherosclerosis (hardening of the arteries), which is a build up of fatty plaque in the wall of the artery which reduces the circulation to the legs. It may cause a narrowing (stenosis) or blockage (occlusion) of the arteries to the legs.
What are the symptoms?
Symptoms vary depending on the severity of the problem. In its mildest form, there may be no symptoms.
Pain in the legs on walking (referred to as claudication) is a symptom of PVD. It is usually felt in the muscles (calf, thigh or buttocks), comes on with walking and is relieved with rest. As the disease advances, the walking distance shortens.
Further reduction in circulation can result in pain at rest. This results in severe, unremitting pain, usually in the feet, worse at night, and relieved by hanging the feet over the edge of the bed. This is a sign that the circulation has reached a precarious stage, and that the limb is threatened.
Ulceration, poor wound healing and tissue loss (e.g: gangrene) are all features of poor circulation to the extremities.
How is the diagnosis confirmed?
Examination may reveal a loss of pulses in the leg. A more accurate assessment of the state of the leg circulation can be obtained by non-invasive Doppler studies in our vascular laboratory.
In the advanced stages, changes may occur to the skin and its appendages, referred to as trophic changes. These include thin, shiny skin, brittle nails and loss of hair. Ruberose (red/blue) discoloration of the skin of the feet (positive Buerger’s test) is a sign of severe impairment of the circulation.
Are any special tests required?
Angiography is still the gold standard for investigating PVD (see more). It may be possible, in some cases to treat the narrowing/blockage at the time of the Angiogram, with balloon angioplasty or stenting.
In some cases, an angiogram can be performed using the CT scan. This is performed using an injection of contrast into a vein. Excellent images can be obtained, but treatment of the blockages is not possible with this technique.
What can be done to treat PVD?
For many patients with PVD, intervention is not required. There can be a spontaneous improvement in walking as alternative or collateral blood vessels open out. Initial management involves risk factor management with advice to quit smoking, lose weight, regular exercise, blood pressure control and dietary advice. Those who stabilise or continue to improve, may not require intervention.
For patients whose symptoms do not improve or stabilise, or those with more severe symptoms of PVD such as rest pain, tissue loss or non-healing ulceration, then intervention is required (see more) . The section below can be revealed :
This may be performed using endovascular techniques (with balloons, catheters and stents) or by open operation.
The choice of intervention depends on numerous factors, such as the location, extent and severity of the blockage.
Where the site of the lesion is a tight narrowing or short blockage, it may be possible to treat with a balloon or stent. If the lesion cannot be treated in this way, operative treatment such as a bypass, or rebore (endarterectomy) may be considered.
What is the success rate?
The success of the procedure, whether endovascular or open, varies depending on numerous factors, and a successful outcome can never be guaranteed. The risks and possible adverse events are discussed in detail in “operations performed”, and vary depending on the precise procedure.