Peripheral Vascular Disease
Peripheral vascular disease (PVD) is the term used to refer to blockages of the arteries to the extremities which reduce nutrient blood flow to the effected areas. It is a common ailment which generally has an increased incidence in older individuals, males, smokers, diabetics, and those people with high cholesterol. While the usual cause is atherosclerotic plaque buildup, there are some less common causes which generally effect younger people.
The most common symptom, occurring in the earliest stages of the disease, is pain or fatigue of the calf muscles brought on by walking a distance, carrying a heavy weight, or climbing stairs. This pain or fatigue, termed claudication, goes away with cessation of the activity and is reproduced by repeating the same activity. The pain or fatigue is caused by the inability of the blocked blood vessels to provide the necessary nutrient blood flow demanded by the exercising leg muscles. With cessation of ambulation blood flow catches up with the demand and the symptoms resolve, usually within 5-10 minutes, allowing return of ambulation for a similar distance before symptoms return.
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At this stage, PVD, while not limb-threatening, can certainly severely compromise the performance of a patient’s activities of daily living. As most patients will not progress to more severe limb-threatening stages of the disease, any decision to treat blocked arteries causing only claudication should be based on an individual patient’s need or desire to ambulate more than their current limitation. However, if the severity of the blockages does worsen, patients are at risk of having inadequate blood flow to meet the demands of even their non-exercising extremities. This can result in gangrene, non-healing sores, or intractable pain in the foot. At this stage the leg is at risk and more aggressive intervention to improve blood flow will be required to save the leg.
Therapeutic options for PVD depend greatly on the location and severity of the blockages. All patients should undergo evaluation and treatment of any contributing conditions such as diabetes, hypertension, or any elevation of cholesterol. In particular, cessation of smoking is critical to long-term improvement, regardless of the therapy employed. In the earliest stages, where claudication is the only symptom, a dedicated exercise program, with or without supplemental medications, may be all that is needed to significantly improve walking tolerance. As the effect of the blockages become more severe, however, endovascular procedures such as balloon angioplasty and stenting or surgical procedures such as bypass grafting may be required to restore sufficient nutrient blood flow to the extremity.
The vascular surgeons at SIU are uniquely qualified to diagnose and treat all stages of PVD by all presently available approved therapeutic approaches. Furthermore, the Division of Vascular Surgery at SIU has a long-standing track record of participation in U.S. FDA clinical investigational trials of new devices and therapies, offering our patients cutting-edge options often not available elsewhere in the region. Using both approved and investigational therapies, the SIU Vascular Surgeons are here to manage all aspects of patients’ PVD, from initial diagnosis and treatment to wound care and long-term follow-up.