OVERLOOK OF PERIPHERAL VASCULAR DISEASE
Peripheral Vascular Disease (PVD) or also known as Peripheral Arterial Disease (PAD), is atherosclerosis or hardening of the arteries -- is a disorder that occurs in the arteries of the circulatory system. Arteries are the blood vessels that carry oxygen and nutrient-rich blood from the heart to all areas of the body. PVD occurs in the arteries that carry blood to the arms and legs.
Healthy arteries have a smooth lining that prevents blood from clotting and promotes steady blood flow. In PAD, the arteries slowly become narrowed or blocked when plaque gradually forms inside the artery walls. Plaque is made of excessive fat, cholesterol and other substances floating through the bloodstream, such as inflammatory cells, proteins and calcium. If the arteries become narrowed or blocked, blood cannot get through to nourish organs and other tissues, causing damage to the tissues and eventually tissue death.
DEVELOPMENT OF PVD
The arteries are shaped like hollow tube. Insides, they are smooth and elastic, allowing blood to flow freely.
PVD starts when fatty deposits start streaking the blood vessel walls. The fatty matter builds up, causing slight injury to the blood vessel walls. In an attempt to heal itself, the cells release chemicals that make the walls stickier. Other substances floating through your bloodstream start sticking to the vessel walls, such as inflammatory cells, proteins and calcium. The fat and other substances combine to form a material called plaque or atherosclerosis.
The plaque builds up and narrows the artery.
Overtime, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are hard on the outside and soft and mushy on the inside. The hard surface can crack or tear, exposing the soft, fatty inside. When this happens, platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots from around the plaque. The artery narrows further. Symptoms occur.
The artery may become completely blocked by plaque or a blood clot that lodges in a narrowed artery. If this occurs, the tissue below the blockage is permanently damaged and may die (gangrene). This most often occurs in the toes and feet.
WHAT ARE THE SYMPTOMS OF PVD?
PVD can build up over a lifetime, and the symptoms may not become obvious until later in life. For many people, the outward symptoms will not appear until the artery has narrowed by 60 percent or more.
▪The first noticeable symptom of PAD may be intermittent claudication -- leg discomfort, heaviness, pain or cramping in the leg muscles that develops with activity, is relieved with rest, and recurs upon resuming activity.
▪The pain is often noticed in the calf, but may also be felt in the buttocks or thighs. Intermittent claudication symptoms may also include numbness, weakness, heaviness or fatigue in the leg muscles when walking that are relieved at rest.
▪The pain can be severe enough to interfere with normal walking. This type of cyclical pain is caused by reduced blood flow to the leg muscles and goes away at rest because the muscles require less blood flow at rest.
Other symptoms of advanced PAD may include:
▪A burning or aching pain in the feet and toes while resting, especially at night while lying flat
▪Cool skin in the feet
▪Redness or other color changes of the skin
▪Increased occurrence of infection
▪Toe and foot sores that do not heal
▪Many people with PAD do not have any symptoms.
HOW IS PVD DETECTED?
A physical exam will be performed and your medical history and risk factors will be reviewed.
Your doctor may order certain tests to help diagnose PVD and determine the severity of the disease.
•The ankle/brachial index (ABI) is a measurement of the blood pressure in the lower legs compared to the blood pressure in the arms. During this test, blood pressure cuffs are placed on the arms and legs. The cuffs are inflated, while a hand-held device (called a Doppler) is used to listen to the blood flow. The ABI screening helps evaluate the amount of blood flow to the legs and feet, which is decreased in a person with PAD. It is a highly accurate method for detecting PAD.
•A vascular ultrasound is a noninvasive test used to examine blood circulation. During a vascular ultrasound, a transducer (small hand- held device) is placed on the skin over the artery to be examined. The transducer emits sound waves that bounce off the artery. These sound waves are recorded, and an image of the vessel is created and displayed on a monitor. This test may be used to detect a blockage in an artery.
Other tests may include angiography, CT scan or MRI.
A CT scan is a technique in which multiple X-rays are taken from different angles in a very short period of time. The images are collected by a computer and cross-sectional “slices” of the blood vessel are shown on the monitor.
MRI uses powerful magnets to create images of internal organs and blood vessels.
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HOW IS PVD TREATED?
Initial treatment of PVD includes making lifestyle changes to reduce your risk factors. Changes you can make to manage your condition include:
•Quit smoking. Ask your doctor about smoking cessation programs available in your community.
•Eat a balanced diet that is high in fiber and low in cholesterol, fat and sodium. Limit fat to 30 percent of your total daily calories. Saturated fat should account for no more than 7 percent of your total calories. Avoid trans fats including products made with partially-hydrogenated and hydrogenated vegetable oils. If you are overweight, losing weight will help you lower your total cholesterol and raise your HDL (good) cholesterol. A registered dietitian can help you make the right dietary changes.
•Exercise. Begin a regular exercise program, such as walking. Walking is very important and can aid the treatment of PVD. Patients who walk regularly can expect a marked improvement in the distance they are able to walk before experiencing leg pain. (Manage other health conditions, such as high blood pressure, diabetes or high cholesterol.
•Practice good foot and skin care to prevent infection and reduce the risk of complications.
•Medications may be recommended to treat conditions such as high blood pressure (anti- hypertensive medications) or high cholesterol (statin medications).
***An antiplatelet medication such as aspirin or clopidogrel (Plavix) may be prescribed to reduce the risk of heart attack and stroke.***
A peripheral angiogram is an imaging test that uses x-ray technology to view your blood vessels in the pelvis, legs, knees, ankles and also, less commonly, the arms and even brain. Specialists often use this test to study narrow, blocked, enlarged or malformed arteries and veins in many areas of the body.
The x-ray images are created by injecting a liquid x-ray dye (an iodine based contrast media) through a thin flexible tube (catheter) into the desired blood vessel from the access point. The access point is usually an incision in the groin. The x-ray contrast media makes the blood flowing in the blood vessel visible on the x-ray monitor. The contrast will be eliminated from your body via the kidneys.
A peripheral angiogram is used to diagnose a variety of conditions, including:
•blockages of the arteries, called PVD
•enlargements of the arteries, called aneurysms;
•kidney artery conditions;
•problems in the arteries that branch off the aorta;
•malformed arteries, known as vascular malformations;
•problems with your veins, such as deep vein thrombosis (DVT); or
•clots in the lungs, known as pulmonary embolism.
AFTER A PERIPHERAL ANGIOGRAM
Your recommended treatment depends on the type and severity of the peripheral artery disease (PAD). Once diagnosed, treatment may include:
•Medicine to help reduce symptoms of leg pain, or claudication
•Peripheral artery bypass surgery to detour around the blockages
•Peripheral angioplasty, atherectomy, and stenting
•Renal artery stenting
•Subclavian artery stenting
•Abdominal aortic aneurysm (AAA) stenting
• In angioplasty, a special catheter with a small balloon at the tip is passed into a narrow portion of the artery and inflated. This compresses the plaque against the walls of the artery.
•The angioplasty is often followed by the placement of a “wire coil” or stent. The stent, an implant, will remain in the artery. Within weeks, new tissue will grow and cover the stent.
•A stent can be implanted at the location of a AAA, preventing rupture
•After your procedure, you will return to a room to recover. You be on bed rest for two to several hours. This depends on what you had done, and the size type, and location of catheters used.
• The staff will keep you comfortable with the use of medicines and position changes.
•Some patients are discharged the same day, but if you received a stent, angioplasty, or atherectomy, you will stay overnight.
• If a stent is placed, you will be started on antiplatelet medication (Plavix, Effient, or Brilinta) and remain on it for a minimum of 6 months, depending on the type of stent used. You should also remain on aspirin. These medicines help to prevent a clot from forming on the stents.
•Do not stop your medication without first talking with your cardiologist.
• Blockage can reoccur with the stent. This may happen within the first 3-6 months.
•This blockage occurs slowly, and you may have a return of symptoms (claudication).
•If this should happen, please contact your doctor soon after you notice the symptoms.
WHAT CAN I DO TO HELP MYSELF?
The most important steps you can take are:
•Quit smoking. Avoid secondhand smoke.
•Be physically active. Follow your provider’s recommendation for your appropriate level of physical activity. For most, walk, ride a bicycle, or do other types of moderate physical activity for at least 30 minutes five days a week.
•Know your blood pressure numbers. Work with your doctor to reach a blood pressure of less than 120/80 mm Hg.
•Lower your blood cholesterol levels by eating healthy foods (high in fiber and low in saturated fat and trans fat) and taking your cholesterol lowering medicine.
•If you have diabetes, work with your doctor to keep your blood sugar under control and reach and maintain an HbA1c of less than 7 percent. HbA1c (hemoglobin A1c) is a blood test that measures your average blood sugar level for the previous 2 to 3 months.
•If you are overweight, set your initial goal at a loss of 5 to 10 pounds. If you need to lose more, a weight loss of 1 to 2 pounds per week is recommended until you reach a healthy weight. Visit our Losing Weight section for more information.
•If you drink alcohol, have only 1 drink a day if you’re a woman, 2 if you’re a man. Learn more about alcohol and heart disease.
SCHEDULE AN APPOINTMENT TODAY!
If you know or believe that you may have PVD or other cardiovascular conditions it is very important that you meet with your cardiologist.
And if you don’t have a cardiologist we are always accepting new patients.
Contacts us at 832-241-2001
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