Diagnosing & Treating Peripheral Vascular Disease How is peripheral vascular disease diagnosed?
Your doctor may find signs of peripheral vascular disease (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 that 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. 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 used to check for an aneurysm of the aorta or blood vessels using 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 can help identify 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 or EKG) - 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 peripheral vascular disease treated?
Treatment for peripheral vascular disease may include:
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 narrowed arteries.
Lifestyle Changes Your physician might recommend that you exercise and walk regularly, stop smoking, and change to a low-fat diet. All of these changes may help 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 This procedure 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, this procedure involves inserting 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 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.
Amputation As a last resort in extreme cases, your surgeon may recommend amputating your lower leg or foot. It is usually performed only when the circulation in your leg is severely reduced and cannot be improved through the methods discussed above.