KING EDWARD MEMORIAL HOSPITAL

Seth Gordhandas Sunderdas Medical College

Acharya Donde Marg, Parel,
Mumbai 400 012. India.
Tel.: 91-22-2410 7000 Fax: 91-22-2414 3435

Peripheral Vascular Disease (P.V.D.)

What is Peripheral Vascualr Disese? (PVD)

Peripheral vascular disease, or P.V.D, is a common yet serious disease that affects people as they age, and increasing the risk of Heart attack and Stroke. P.V.D. (or Bad Circulation) is a condition in which the arteries that carry blood to the arms or legs become narrow due to deposition of fatty material in their walls. When the deposits of fatty material reduces the blood flow significantly, then the limbs start aching on walking. Such aching subsides on taking rest. The most common cause of P.V.D is atherosclerosis (often called hardening of the arteries). Atherosclerosis is a gradual process in which fat, cholesterol and other substances accumulate in the walls of the arteries forming a substance called “plaque” that clogs the blood vessels.

Since atherosclerosis is a generalized disorder, P.V.D. is a collator for all diseases caused by the obstruction of large Blood Vessels in the body. It may not be confined to one artery but may involve arteries in other areas of the body as well. Some of the more commonly affected areas are the arteries of the kidneys (Renals), neck (Carotids) and the most important being the HEART. Stroke, Heart attack and gangrene of legs are the most obvious consequence of such damaged arteries.

Timely detection and treatment of P.V.D. can improve your quality of life, and help reduce your risk of having Stroke, leg amputation and even death.

What are the symptoms of PVD?

Symptoms of P.V.D:

  • Leg or hip pain during walking
  • The pain stops when you rest
  • Numbness and tingling of legs
  • Burning or aching pain in feet or toes when resting
  • Ulcer on leg and heel that won’t heal
  • Cold legs and feet
  • Colour changes in skin of legs or feet
  • Loss of hair on legs

What are the risk factors for PVD?

Risk Factors for P.V.D:

Those who are at highest risk are:

  • Over the age of 50,
  • Smokers,
  • Diabetics,
  • Overweight people,
  • People who do not exercise, or
  • People who have high blood pressure,
  • High cholesterol

A family history of heart or Cardio- vascular disease may also put you at higher risk for P.V.D. Remember that if you have P.V.D. than the risk of Heart Attack and Stroke is higher.

The most common screening test for P.V.D. is the Ankle-Brachial Index (ABI) , a painless test in which a special stethoscope is used to compare the blood pressures in your feet and arms.

Peripheral Vascular Disease (P.V.D.) : Treatment:

In some cases, lifestyle changes are enough to halt the progress of P.V.D. and manage the disease. Sometimes, medications or procedures that open up clogged blood vessels are given to treat PVD.

Exercise

Regular exercise is the most effective treatment for P.V.D.

Regular aerobic exercise like walking at a medium pace for 30 to 40 minutes, three to four times a week provides optimal benefits for the legs as well as for the heart.

Some people may have a medical condition that prevents them from participating in an exercise program. Consult your physician before undertaking any exercise or other treatment program.

Diet

Limit intake of saturated fat, for example, meat, egg –yolk, dairy products, coconut oil, yogurt, coffee, salt, fried junk food and sugars (chocolates and pastries).

It is advisable to eat high fiber foods such as vegetables, fresh fruits and whole grains. Oat bran, apples, olive oil, almonds, millet (ragi) and rice –bran oil (RBO – The Indian Olive oil) all help reduce cholesterol levels. In fact, RBO is also supposed to have significant cholesterol-and triglyceride-reducing properties, The cholesterol reducing property is attributed to the presence of a unique anti-oxidant, oryzanol, which is not found in any other edible oil. Try to include them in your diet everyday. Strict dietary discipline can lower cholesterol levels by upto 10%.

Stop Smoking

There is no doubt that cigarette smoking is a strong risk factor for P.V.D. and heart disease. On an average, smokers are diagnosed with PVD as much as 10 years earlier than non-smokers. Stopping smoking now is the single most important thing you can do to halt the progression of P.V.D. or prevent it in the future. In fact, stopping smoking reduces your risk of even heart attack within a year and renders you equal to a non-smoker in three years.

Medications

Vitamin B Complex, especially B3 and B6 are essential for fat metabolism and help support the liver, a hard working organ that processes fat. Vitamin E (400 IU daily) helps circulation, magnesium and potassium regulate heart spasms. Vitamin C reduces bad cholesterol in the blood. Good dietary sources of B vitamins include dark-green leafy vegetables, citrus fruits and juices, dried beans, nuts, oatmeal, wheat germ, and yeast.

Aspirin and other blood-thinning agents may be taken under medical supervision to improve blood circulation.

Drugs that lower cholesterol (Statins) or control high blood pressure may be prescribed. New medications that help prevent blood clots or the build up of plaque in the arteries, or that reduces the pain of P.V.D., are also appropriate for some patients.

Endovascular Treatment for P.V.D.:

Angioplasty — In this procedure, an Endovascular Specialist inserts a very small balloon attached to a thin tube (catheter) into a blood vessel through a small puncture in the skin at the groin. The catheter is threaded under X-ray guidance across the site of the narrow or blocked artery. The balloon is then inflated to open the artery.

Stents — In some cases, a tiny spring-like cylinder made of biocompatible metal mesh called stent, is inserted in the clogged vessel to act like scaffolding and keep the artery widely open after Angioplasty.

Thrombolytic therapy — An Endovascular Specialist uses this treatment if the blockage in the artery is caused by a blood clot. Thrombolytic drugs—sometimes called “clot busters”—dissolve the clot and restore blood flow. Usually, the drugs are administered through a spray directly into the clot. This treatment is sometimes combined with another treatment, such as angioplasty if the clot is too rigid.

Stent-grafts — a Stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.

Surgical Treatments for P.V.D.

Thrombectomy. This procedure is used only when symptoms of P.V.D. develop suddenly as a result of a blood clot. In the technique, a balloon catheter is inserted into the affected artery beyond the clot. The balloon is inflated and pulled back, bringing the clot with it. Thrombectomy is a small surgical procedure.

Bypass grafts. In this procedure, a vein graft from another part of the body or a graft made from artificial material is used to create a detour around a blocked artery.

The Best Treatment for PVD:

The best treatment for PVD depends on a number of factors, including your overall health, the location of the affected artery, and the size and cause of the blockage or narrowing in the artery.

You should discuss all your treatment options with your Endovascular Specialist.

Notices and News