Peripheral Vascular Disease

What is peripheral vascular disease?

Peripheral vascular disease (PVD) is a slow and progressive disorder of the blood vessels. Narrowing, blockage, or spasms in a blood vessel can cause PVD.

PVD may affect any blood vessel outside of the heart. This includes the arteries, veins, or lymphatic vessels. Organs supplied by these vessels, such as the brain or legs, may not get enough blood flow for healthy function. The legs and feet are most often affected.

Peripheral vascular disease is also called peripheral arterial disease (PAD). 

What causes peripheral vascular disease?

The most common cause of PVD is atherosclerosis. This is the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs. It decreases the oxygen and nutrients sent to the tissue. Blood clots may form on the artery walls. This makes the inner size of the blood vessels even smaller and blocks off major arteries.

Other causes of PVD may include:

  • Injury to the arms or legs
  • Irregular anatomy of muscles or ligaments
  • Infection

People with coronary artery disease (CAD) often also have PVD. 

Who is at risk for peripheral vascular disease?

Risk factors that you can’t change include:

  • Age (higher risk over age 50)
  • History of heart disease
  • Male gender
  • Postmenopausal women
  • Family history of high cholesterol, high blood pressure, or peripheral vascular disease

Risk factors that may be changed or treated include:

  • Coronary artery disease
  • Diabetes
  • High cholesterol
  • High blood pressure
  • Overweight
  • Physical inactivity
  • Smoking or use of tobacco products

Those who smoke or have diabetes have the highest risk of complications from PVD. This is because these risk factors cause impaired blood flow. 

What are the symptoms of peripheral vascular disease?

About half the people diagnosed with PVD have no symptoms. For those with symptoms, the most common first symptom is painful leg cramping that occurs with exercise and is relieved by rest. This is known as intermittent claudication. During rest, the muscles need less blood flow, so the pain disappears. It may occur in 1 or both legs. This depends on the location of the clogged or narrowed artery.

Other symptoms of PVD may include:

  • Changes in the skin, including decreased skin temperature, or thin, brittle, shiny skin on the legs and feet
  • Weak pulses in the legs and the feet
  • Gangrene (dead tissue due to lack of blood flow)
  • Hair loss on the legs
  • Impotence
  • Wounds that won’t heal over pressure points, such as heels or ankles
  • Numbness, weakness, or heaviness in muscles
  • Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
  • Paleness when the legs are elevated
  • Reddish-blue discoloration of the extremities
  • Restricted mobility
  • Severe pain when the artery is very narrow or blocked
  • Thickened, opaque toenails

The symptoms of PVD may look like other conditions. See your healthcare provider for a diagnosis. 

How is peripheral vascular disease diagnosed?

Your healthcare provider will ask about your medical history. They will give you a physical exam. You may also have tests such as:

  • Angiogram. This is an X-ray of the arteries and veins to find blockage or narrowing. This procedure is done by putting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
  • Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm. It is done using a regular blood pressure cuff and a Doppler ultrasound device. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm. 
  • Doppler ultrasound flow studies.  This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Your doctor may use the Doppler test to measure and assess the flow of blood. Faintness or absence of sound may mean blood flow is blocked. 
  • Magnetic resonance angiography (MRA).  This noninvasive test uses a large magnet, radio waves, and a computer to make detailed images of organs and other tissues in the body. Your doctor injects a special dye during the procedure. This is done so that blood vessels are more visible. 
  • Treadmill exercise test. For this test, you will walk on a treadmill so your doctor can monitor blood flow during exercise.
  • Photoplethysmography (PPG).This exam is comparable to the ankle brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements. Your doctor can then compare these measurements to the systolic blood pressure in the arm.
  • Pulse volume recording (PVR) waveform analysis. Your doctor uses this test to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.
  • Reactive hyperemia test. This test is similar to an ABI or a treadmill test but used for people who can’t walk on a treadmill. While you are lying on your back, your doctor takes comparative blood pressure measurements on the thighs and ankles to determine any decrease between the sites.