Alternate Names: Peripheral vascular disease; PVD; Arteriosclerosis obliterans
Causes and Risks: Arteriosclerosis ("hardening of the arteries") commonly shows its effects first in the legs and feet. The narrowing of the arteries may progress to total closure (occlusion) of the vessel. The vessel walls become less elastic and cannot dilate to allow greater blood flow when needed (such as during exercise). Calcium deposits in the walls of the arteries contribute to the narrowing and stiffness. The effects of these deposits may be seen on plain X-rays.
It is a common disorder usually affecting men over 50 years old. Twenty percent of people over age 64 will suffer from arteriosclerosis of the extremities.
Persons are at higher risk if they have a personal or family history of coronary artery or cerebrovascular disease, diabetes mellitus, smoking, hypertension, or kidney disease involving hemodialysis.
Prevention:
Control risk factors such as obesity, hypertension, and smoking.
Symptoms:
Often, symptoms affect one limb. If arteriosclerosis exists in both limbs, the intensity is usually different.
Signs and Tests:
An examination may show arterial bruits (whooshing sound heard with the stethoscope over the artery), decreased or absent pulse in the extremities, or decreased blood pressure in the affected extremity.
A lipid profile may show hyperlipidemia (lipid serum is increased, total cholesterol is increased).
Peripheral artery disease may be revealed by:
Treatment:
Treatment focuses on the relief of symptoms and self-care to improve circulation.
Medications may be required to control the disorder, including analgesics to control pain, pentoxifylline (in some cases), and medications such as vasodilators or antiplatelet agents.
Surgery is usually performed only on severe cases where the ability to work or pursue essential activities is affected. This may consist of surgical removing of the lining of the artery (endarterectomy), repair or replacement of the vessel (grafting), or most commonly, bypass surgery using a vein or synthetic graft.
Alternatives to surgery may include treatments such as balloon angioplasty (a similar technique to that used to open the coronary arteries, but performed on the blood vessels of the affected extremity), sometimes followed by stent implantation, laser, or other treatments.
Self-care:
Exercise must be balanced with rest. This is often recommended as walking or other exercise performed to the point of pain, alternated with rest periods. Over time, circulation improves because of the development of collateral (new, small) blood vessels.
Stop smoking! Smoking constricts arteries, decreases the blood’s ability to carry oxygen, and increases the risk of forming clots (thrombi and emboli).
Foot care is particularly important if diabetes mellitus is also present. Wear shoes that fit properly. Pay attention to any cuts, scrapes, or injury--the tissues heal slowly when there is decreased circulation, and they are prone to infection.
If cholesterol is high, change the diet to a low-cholesterol diet.
Prognosis: Arteriosclerosis of the extremities is usually controllable with treatment. Surgery provides good relief of symptoms. Complications may require amputation of the extremity.
Complications:
Call for an appointment with the health care provider if symptoms indicate arteriosclerosis of the extremities.
Call for an appointment with the health care provider if new symptoms develop, especially formation of new sores/ulcers or signs of infection (fever, redness, general ill feeling, or joint pain).
