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Understanding Peripheral Vascular Disease

Vascular medicine and surgery primarily focuses on diseases and disorders of the peripheral vascular system: feet, hands, legs and arms. The health of the peripheral vascular system has a major impact on the health of your overall circulatory system and your overall health, and a vascular screening can reveal the first signs of more serious problems, which is why we offer comprehensive screenings to all our patients.

Many other vascular disorders, such as varicose veins, spider veins, and blood blockages that cause localized pain, have moved from the hospital and can now be treated on an outpatient basis. Thanks to our combination of advanced imaging and expertise in micro-surgery, most of the vascular screenings and procedures VCU Health at Baird Vascular Institute provide are minimally invasive, virtually pain free, and require little to no down time.

In all cases, our first priority is the health of your circulatory system and your overall well-being.

The Circulatory System

When your heart beats, it pumps blood back and forth through a complex system of vessels, called the circulatory, or vascular system. These arteries and veins, ranging from very large to microscopic, are elastic tubes that carry the blood to and from every part of the body. The heart pumps oxygen-rich blood from the lungs through arteries, and veins carry the blood back to the heart into the lungs, which remove CO2 and other waste from the blood and replenish it with fresh oxygen. This cycle supplies all the muscles, organs and tissues of the body with the oxygen and nutrients they need to work.

Vascular disease can cause these vessels to narrow, harden, swell, form blood clots or get partially or entirely blocked. When this happens, the tissues fed by these vessels are robbed of the oxygen and nutrients. Sometimes pain in the affected area will signal a problem. At other times, vascular disease shows few symptoms as it worsens over time, sometimes with serious consequences.

Although usually associated with older people, vascular disease can affect almost anyone and may present itself in all areas of the body.

What is Vascular Disease?

Vascular diseases range from diseases of the arteries, veins and lymph vessels to blood disorders that affect circulation. Among the most common types of vascular disease are peripheral vascular disease (PVD), peripheral artery disease (PAD) and coronary artery disease. The terms peripheral vascular disease and peripheral artery disease are often used interchangeably, but we discuss both here. Many of the problems we diagnose and treat involve peripheral vascular disease in one degree or another.

Peripheral Vascular Disease

Peripheral vascular disease (PVD) is a disease of the blood vessels (arteries and veins) located outside the heart and brain. Among conditions associated with PVD affecting the veins are:

  • Deep vein thrombosis (DVT)
  • Varicose veins and spider veins
  • Chronic venous insufficiency
  • Lymphedema – a type of PVD that affects the lymphatic vessels, essential to the body’s immune system

PVD is caused by the same atherosclerotic plaque that causes coronary artery disease, a build up of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood) that causes a blood vessel to thicken, harden and interfere with blood flow.

Frequently, the atherosclerosis causing PVD is not confined to one artery but may involve arteries in other areas as well. The more commonly affected areas are the legs, arms, kidneys and neck. When the blood flow is decreased, the primary symptom is pain. The most common symptom is leg pain that starts when exercising and stops during rest. Other localized pain, numbness or sensitivity to cold in the legs, feet, arms or fingers are also symptoms.

Peripheral Artery Disease

The most common type of peripheral vascular disease (PVD) is peripheral artery disease (PAD). Like the blood vessels of the heart (coronary arteries), your peripheral arteries (blood vessels outside the heart) also may develop atherosclerosis. Over time, the plaque buildup narrows the artery, causing increased pressure in the blood vessel. Eventually, the inside of the artery narrows so much that it restricts blood flow and less oxygen is delivered to the tissues, causing a condition called ischemia, an inadequate supply of blood that causes tissue damage.

If a fragment of this plaque from any part of the body breaks loose and clogs one of the arteries supplying the heart itself, the result is a heart attack. If a fragment breaks and blocks an artery going to the brain, a stroke will result. Narrowing of the arteries that supply the kidneys with blood can cause high blood pressure and kidney failure. Any tissue that does not have an adequate supply of blood and oxygen will, over time, become permanently damaged and die. That it is critical to diagnose and treat peripheral vascular diseases before it becomes a more serious problem.

In the early stages of PAD, symptoms include cramping and pain in the legs and buttocks, indicating poor circulation in the legs. Other common symptoms include fatigue, heaviness and discomfort during exercise or activity. These symptoms generally go away when the activity stops or you are resting. This is called "intermittent claudication."

These are early warning signs. If left undiagnosed and untreated, the symptoms of severe PAD intensify:

  • Leg pain that does not go away when you stop exercising
  • Foot or toe wounds that don't heal or heal very slowly
  • A decrease in the temperature of your lower leg or foot, particularly compared to the other leg or the rest of your body.

What are the Risk Factors of Peripheral Artery Disease?

The most common type of peripheral vascular disease (PVD) is peripheral artery disease (PAD), which affects about 8 million Americans. Atherosclerosis can start as early as the age of 20, and becomes more common as one gets older. By age 65, about 12 to 20 percent of the population has some degree of vascular disease. The exact cause is unknown, but several risk factors are known to accelerate the formation of fatty deposits, or plaque, in the arteries:

  • Smoking
  • Family history of vascular disease, angina, heart attacks or stroke
  • Being overweight
  • An unhealthy diet
  • Lack of exercise
  • Diabetes
  • Being male
  • High blood pressure
  • High cholesterol levels
  • Stress

Early diagnosis is critical, as people with PAD have a four to five times higher risk of having a heart attack or stroke. Unfortunately, PAD often goes undiagnosed as symptoms are often mistaken for something else.

Diagnosis and Treatment

VCU Health at Baird Vascular Institute provides diagnosis and treatment for peripheral vascular disease. Arterial conditions affecting the heart or brain require a more complex and critical course of treatment, and we refer these patients to the full treatment capabilities of our colleagues at the VCU Medical Center. However, many peripheral vascular conditions can be diagnosed and treated on an outpatient basis by the interventional radiologists and vascular surgeons here at VCU Baird Vascular Institute.

The diagnosis of vascular disease is made on the basis of your medical history and symptoms, and generally begins with a physical exam, either by your health care provider or by our doctors.

During your exam, the doctor first checks for weak pulses in the legs. From there, your examination may also include:

  • Ankle-brachial index (ABI): A painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes only a few minutes and can be performed as part of a routine exam. Normally, ankle blood pressure is at least 90 percent of the arm pressure. With PVD, it may be less than 50 percent. If there is an abnormal difference, you may require more testing. This is when your doctor may refer you to VCU Health at Baird Vascular Institute for testing and further diagnosis, where we can provide specialized vascular examinations, including:
    • Doppler and ultrasound (duplex) imaging: A completely safe, noninvasive technology that uses sound waves to visualize an artery and measure blood flow to locate the presence of a blockage.
    • Angiography: This procedure is generally reserved for use in conjunction with vascular treatment procedures. During an angiogram, a contrast agent is injected into the artery and x-rays are taken to show blood flow and arteries in the legs and to pinpoint any blockages that may be present.

At VCU Baird Vascular Institute, we have the latest in technology and techniques to diagnose and treat vascular disease and help you get back into good health. If we uncover signs of vascular disease, our experts can develop a custom treatment plan for you.

If you want to learn more about peripheral vascular disease (PVD) and treatment options, wish to discuss symptoms or problems you may be experiencing or if your doctor has recommended that you see us for a vascular test, please contact us at (804) 828- 2600 or email us.