Doctor's Notes on Peripheral Vascular Disease (PVD)
The term peripheral vascular disease usually refers to peripheral artery disease (PAD), which is the narrowing or occlusion of arteries outside of the heart and brain by by atherosclerotic plaques. This means that blood circulation from the heart to the body is decreased. Atherosclerosis is caused by a number of conditions. Risk factors for peripheral artery disease include elevated blood cholesterol, smoking, high blood pressure, diabetes, overweight, and a sedentary lifestyle.
Symptoms and signs of peripheral vascular disease depend on the extent and location of the blockage in the artery. The classic symptom of peripheral artery disease is intermittent claudication, which is pain in the calf or lower leg that comes on while walking and goes away at rest. Associated symptoms can include pain that worsens continuously with activity until it becomes unbearable and pain at rest if the arterial blockage is severe.
Peripheral Vascular Disease (PVD) Symptoms
Only about half of the individuals with peripheral vascular disease have symptoms. Almost always, symptoms are caused by the leg muscles not getting enough blood. Whether you have symptoms depends partly on which artery is affected and to what extent blood flow is restricted.
The most common symptom of peripheral vascular disease in the legs is pain in one or both calves, thighs, or hips.
- The pain usually occurs while you are walking or climbing stairs and stops when you rest. This is because the muscles' demand for blood increases during walking and other exercise. The narrowed or blocked arteries cannot supply more blood, so the muscles are deprived of oxygen and other nutrients.
- This pain is called intermittent (comes and goes) claudication.
- It usually is a dull, cramping pain. It may also feel like a heaviness, tightness, or tiredness in the muscles of the legs.
- Cramps in the legs have several causes, but cramps that start with exercise and stop with rest most likely are due to intermittent claudication. When the blood vessels in the legs are completely blocked, leg pain at night is very typical, and the individual almost always hangs his or her feet down to ease the pain. Hanging the legs down allows for blood to passively flow into the distal part of the legs.
Other symptoms of peripheral vascular disease include the following:
- Buttock pain
- Numbness, tingling, or weakness in the legs
- Burning or aching pain in the feet or toes while resting
- A sore on a leg or a foot that will not heal
- One or both legs or feet feel cold or change color (pale, bluish, dark reddish)
- Loss of hair on the legs
Having symptoms while at rest is a sign of more severe disease.
Peripheral Vascular Disease (PVD) Causes
The most common cause of peripheral vascular disease is atherosclerosis, or hardening of the arteries, a gradual process by which cholesterol plaques (material) builds up and causes inflammation in the inner walls of the arteries. This cholesterol plaque builds up over time and may block, narrow, or weaken the blood vessel walls, which results in restricted or blocked blood flow.
Other causes of peripheral vascular disease include:
- Blood clot: A blood clot can block a blood vessel (thrombus/emboli).
- Diabetes: Over the long-term, the high blood sugar level of persons with diabetes can damage blood vessels. This makes the blood vessels more likely to become narrowed or weakened. Plus, people with diabetes frequently also have high blood pressure and high fats in the blood, which accelerates the development of atherosclerosis.
- Inflammation of the arteries: This condition is called arteritis and can cause narrowing or weakening of the arteries. Several autoimmune conditions can develop vasculitis, and, besides the arteries, other organ systems are also affected.
- Infection: The inflammation and scarring caused by infection can block, narrow, or weaken blood vessels. Both salmonellosis (infection with Salmonella bacteria) and syphilis have been two infections traditionally known to infect and damage blood vessels.
- Structural defects: Defects in the structure of a blood vessel can cause narrowing. Most of these cases are acquired at birth, and the cause remains unknown. Takayasu disease is a vascular disease affecting the upper vessels of the body and affects usually Asian females.
- Injury: Blood vessels can be injured in an accident such as a car wreck or a bad fall.
Spider veins and varicose veins are common conditions that affect many adults. These abnormally enlarged vessels, which affect women more often than men, appear most often on the legs and become more prevalent with age. Spider veins and varicose veins affect up to 50% of the adult population. The following slideshow will highlight the important facts about spider veins and varicose veins, with accompanying pictures to better understand what they look like, what they are, and how to treat them.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.