Peripheral Vascular Disease (PVD): Causes, Symptoms, and Treatment

Peripheral Vascular Disease (PVD) refers to a group of conditions that affect the blood vessels outside the heart and brain, most commonly the arteries supplying the legs. When these vessels become narrowed or blocked, blood flow to the limbs reduces, leading to pain, mobility problems, and an increased risk of serious complications. With early diagnosis and proper treatment, symptoms can be controlled and long-term outcomes improved.

Causes of Peripheral Vascular Disease

PVD is most commonly caused by atherosclerosis, a condition in which fatty deposits (plaque) build up on the inner walls of blood vessels, narrowing and hardening them over time. Other contributing factors include:

• Diabetes and long-standing high blood sugar levels.
• Smoking and tobacco use.
• High blood pressure (hypertension).
• High cholesterol and triglycerides.
• Obesity and sedentary lifestyle.
• Aging and family history of vascular disease.

Symptoms of PVD

Symptoms vary depending on the severity of narrowing and the extent of reduced blood flow. Common features include:

• Claudication: Pain or cramping in the legs, especially during walking or exercise, which improves with rest.
• Numbness, weakness, or heaviness in the legs.
• Coldness in the lower legs or feet compared with the other side.
• Slow-healing wounds or ulcers on the legs or feet.
• Skin colour changes, thinning of skin, or hair loss on the legs.
• Weak or absent pulses in the feet or ankles.

Who Is at Higher Risk?

PVD is more common in people over 50 years of age, especially those with:

• A history of smoking or tobacco use.
• Diabetes or pre-diabetes.
• High blood pressure or high cholesterol.
• Heart disease or stroke.
• A family history of vascular disease.

Diagnosis of PVD

Early and accurate diagnosis is crucial to prevent complications:

• Ankle–Brachial Index (ABI): A simple test that compares blood pressure in the ankle and arm to detect reduced blood flow.
• Doppler ultrasound: Non-invasive imaging to assess blood flow and look for narrowed or blocked arteries.
• CT/MR angiography: Detailed imaging with contrast to map blockages.
• Conventional angiography: A catheter-based test for precise assessment and planning of intervention.

Treatment Options

Treatment aims to improve blood flow, relieve symptoms, and reduce the risk of heart attack, stroke, and limb-threatening complications.

1. Lifestyle and Medical Management

• Quitting smoking and avoiding all tobacco products.
• Adopting a heart-healthy diet and maintaining a healthy weight.
• Regular, supervised exercise (walking programs) to improve circulation.
• Medications to control blood pressure, cholesterol, and diabetes.
• Antiplatelet drugs to reduce the risk of clot formation.

2. Minimally Invasive Procedures

• Angioplasty: Balloon expansion of narrowed arteries to restore blood flow.
• Stenting: Placement of a small metal scaffold to keep the artery open.

3. Surgical Treatment

• Bypass surgery: Creating an alternate pathway for blood flow around a blocked segment using a vein or synthetic graft.
• Management of non-healing ulcers and, in severe cases, limb-saving procedures.

Complications of Untreated PVD

If PVD is not recognised and treated in time, it can lead to:

• Chronic limb ischemia and persistent rest pain.
• Non-healing wounds, ulcers, or gangrene.
• Increased risk of heart attack and stroke.
• Need for partial or major limb amputation in advanced cases.

Prevention and Long-Term Care

• Maintain a healthy weight and active lifestyle.
• Keep blood sugar, blood pressure, and cholesterol well controlled.
• Avoid smoking and second-hand smoke exposure.
• Attend regular follow-ups with your vascular specialist.

Peripheral Vascular Disease is a serious but manageable condition. With early diagnosis, lifestyle changes, and appropriate treatment, its impact on your mobility and health can be greatly reduced. If you notice leg pain on walking, cold feet, or slow-healing wounds, consult a vascular specialist to discuss your options and protect your circulation.