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Peripheral Vascular Disease (PVD) is the process of atherosclerosis (hardening of the arteries) in arterial blood vessels other than those in the heart. Just as the arteries for the heart can become blocked or narrowed by plaque formation, so can the arteries of the legs, feet, arms, stomach, kidneys, and neck. Blockage of blood flow deprives these vital organs and muscles of oxygen and blood, resulting in a number of symptoms - some of which can be life threatening.
Risk factors for developing PVD include diabetes, heart disease, cigarette smoking, hypertension, high cholesterol and advanced age.
How is it diagnosed?
Your doctor may find signs of PVD during a physical examination. These include:
- A weak or absent pulse below a narrowed area of your artery.
- Whooshing sounds (bruits) over your arteries that can be heard with a stethoscope.
- Evidence of poor wound healing in the area where your blood flow is restricted.
- Decreased blood pressure in your affected limb.
Your doctor may also rely on one or more of the following tests to diagnose PVD:
- Ankle-brachial index (ABI) - a diagnostic test compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
- Angiography - this form of imaging allows your doctor to view blood flow through your arteries as it happens. By injecting a contrast material (dye) into your blood vessels, your doctor is able to trace the flow of the contrast material using imaging machines. Angiography can be done using X-ray imaging or procedures called magnetic resonance angiography (MRA) or computed tomography angiography (CTA).
- Ultrasound - a test that is done to make sure you do not have an aneurysm of the aorta or blood vessels by utilizing sound waves to illuminate structures (create pictures) so blood flow deficiencies can be detected. This can be combined with walking on a treadmill.
In addition to these tests, your doctor will be concerned with identifying your risk of heart attack and stroke. You may undergo a variety of tests aimed at assessing your risk for these problems, including:
- Electrocardiogram (ECG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage. Your doctor may monitor an ECG during and after the treadmill test.
- Blood tests - doctors can check your blood to measure cholesterol and check the level of C-reactive protein, which is a marker for heart disease.
How is it treated?
- Medication - your physician may recommend medication to treat conditions that worsen or complicate leg artery disease. These medications may include cholesterol or blood-pressure-lowering drugs, or medications that reduce blood clotting to minimize the chances of clots blocking your narrowed arteries.
- Lifestyle Changes - your physician might recommend that you exercise and walk regularly, stop smoking, and change your diet to a low fat diet. All of these changes may help to improve your symptoms.
In more severe cases, lifestyle and medication may not be enough to improve your symptoms, and your physician may recommend surgical or minimally invasive treatments. Treatment decisions depend on the pattern and extent of the blockages as well as other factors, such as your general health and the presence of other medical conditions.
- Bypass Surgery - creates a detour around a narrowed, or blocked, section of a leg artery. To create this bypass, your vascular surgeon uses one of your veins or a tube made from man-made materials. The bypass is attached above and below the area that is blocked, creating a new path for blood to flow to your leg tissues.
- Endarectomy - your vascular surgeon makes an incision in your leg and removes the plaque contained in the inner lining of the diseased artery. This leaves a wide-open artery and restores blood through your leg artery.
- Angioplasty and stenting - less invasive than surgery, your physician inserts a long, thin, flexible tube called a catheter into a small puncture over an artery in your arm or groin. The catheter is guided through your arteries to the blocked area. Once in place, a special balloon that is attached to the catheter is inflated and deflated several times, pushing the plaque in your artery against your artery walls, widening the vessel. In some cases, a tiny mesh-metal tube, called a stent, is permanently placed into the narrowed area of your artery to keep it open and allow blood to flow through freely.
- Through Amputation - as a last resort in extreme cases, your surgeon may recommend amputating your lower leg or foot. It is usually only performed when the circulation in your leg is severely reduced and cannot be improved through the methods discussed above.
How does Advocate Christ Medical Center make a difference?
Our physicians have extensive experience in traditional surgical procedures as well as proven, minimally invasive methods to clear blockages in the arteries and treat peripheral vascular disease without surgery, and with excellent results. We have experience using the newest techniques available and are one of the few hospitals in the region able to care for the most complicated cases.
With some of the area's leading cardiologists, we have the opportunity to test new therapies. Christ Medical Center was one of the first hospitals to do carotid stenting and one of the first to do an atherectomy for blockage in the legs.
The board certified vascular surgeons at Advocate Christ Medical Center treat a full range of vascular problems, taking care of all the blood vessels with the exception of the heart: aortic aneurysms, carotid artery disease, peripheral arterial sclerotic disease of the arms and legs, stomach and kidney, dialysis access, venous disorders and diabetic ulcers. We take a multi-disciplinary approach to vascular issues, which is important because patients who have vascular disease frequently have heart disease or other problems. For that reason, our vascular surgeons work closely with our cardiac and thoracic surgery team.
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