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Peripheral Interventions

Peripheral Vascular Disease

Peripheral vascular disease is the reduced circulation of blood to a body part other than the brain or heart. It is caused by a narrowed or blocked blood vessel. The arterial form, usually referred to as peripheral arterial disease, is caused by deposits of fatty material (atheroma) in arteries of the legs. PAD is usually caused by a gradual buildup of plaque within the arteries (atherosclerosis). Peripheral vascular disease mainly affects blood vessels of the legs and kidneys. Other causes include blood clots or embolisms, congenital heart disease, and inflammation of the blood vessels (vasculitis). PAD can be hereditary. More commonly, you may get PAD if you are overweight or obese, or have high blood pressure, diabetes, or high cholesterol. Unhealthy lifestyle choices such as smoking, eating a high-fat diet, and not exercising enough frequently lead to PAD. A person with peripheral vascular disease is up to six times more likely to have a heart attack or stroke.

Symptoms of Peripheral Vascular Disease

In some cases, a person with peripheral vascular disease does not have any symptoms until the condition is advanced and severe. Symptoms depend on which body part is deprived of sufficient blood, but may include:

  • Intermittent pain (claudication), which feels like cramps, muscle fatigue or heaviness (usually in the legs)
  • Worsening pain during exercise (usually in the legs)
  • Easing of pain during rest (usually in the legs)
  • Coldness of the affected body part
  • Numbness
  • Pins and needles
  • Muscular weakness
  • Blue or purple tinge to the skin
  • Wounds that won’t heal (vascular ulcers)
  • Blackened areas of skin or skin loss (gangrene).

Gangrene Information

Body tissues rely on a steady supply of blood to deliver oxygen and nutrients. A narrowed or blocked blood vessel deprives tissues of blood. Gangrene is the death and decay of tissue. There is no cure. The only treatment is surgical amputation of the affected body part.

Causes of Peripheral Vascular Disease

In most cases the cause is atherosclerosis, the build-up of fatty deposits within the blood vessel that reduces blood flow to the area. Commonly this occurs in the body where a blood vessel kinks or subdivides.

Apart from fatty deposits, other causes of peripheral vascular disease include:

  • Diabetes – high blood sugar damages and weakens blood vessels, causing them to narrow.
  • Obstruction – a blood clot (thrombus) may lodge within the blood vessel.
  • Infection – can cause scarring and narrowing of the blood vessels. Syphilis or salmonellosis, for example, can lead to peripheral vascular disease.
  • Arteritis – inflammation of arteries. Some autoimmune diseases can cause arteritis.
  • Blood vessel defects – blood vessels may be unusually narrow at birth. The cause is unknown.
  • Blood vessel spasms – conditions such as Raynaud’s disease may cause narrowing of blood vessels in response to certain factors, including cold temperatures or stress.

Risk factors for Peripheral Vascular Disease include:

  • Diabetes – this is the most significant risk factor
  • Cigarette smoking
  • Advancing age
  • Family history of peripheral vascular disease, stroke or coronary artery disease
  • Medical history of stroke, cardiovascular disease or heart attack
  • Overweight or obesity
  • Sedentary lifestyle
  • High blood pressure (hypertension)
  • High blood cholesterol (hypercholesterolaemia)

Diagnosis of Peripheral Vascular Disease may include:

  • Medical history
  • Physical examination
  • Family history
  • Pulse check, using a stethoscope to listen for signs of reduced blood flow through a blood vessel
  • Ankle/brachial index (ABI) test, which compares the blood pressure readings of the arms and legs to check for differences
  • Exercise test, usually performed on a treadmill while blood pressure is taken to check for a drop in blood pressure within the affected body part
  • Non-invasive scans such as ultrasound, CT (computed tomography), or magnetic resonance imaging (MRI) to locate narrowed sections of blood vessels
  • Angiography, the injection of a contrast dye into the blood vessel can be visualized in real time upon x-ray examination to look for any obstructive disease

Treatment of Peripheral Vascular Disease

  • Medications – to help treat atherosclerosis, such as statins to lower LDL cholesterol and antihypertensive drugs to lower blood pressure.
  • Drugs to treat blood clots – treatment may include various medications (including anticoagulants and anti-platelet drugs) to prevent blood clots from developing and medications (including thrombolytics) that dissolve existing blood clots.
  • Angioplasty – this procedure, usually performed under sedation and local anaesthetic, involves threading a thin tube (catheter) into the narrowed blood vessel through a small incision, usually in the leg. Once the catheter reaches the narrowed or blocked site, the small balloon on its tip is inflated. This widens the blood vessel and improves blood flow. Angioplasty is usually considered as a temporary measure.
  • Percutaneous insertion of a stent – a stent is a metal ‘sleeve’ that is implanted inside the narrowed blood vessel during an angioplasty procedure to prop it open. Stents may be impregnated with medications that help to prevent scar tissue from narrowing the treated area of blood vessel.
  • Atherectomy – this procedure involves “cutting away” the fatty obstruction with a small rotational drill-like instrument from the inside of the artery itself.
  • Bypass surgery – this operation is usually only considered in severe cases that don’t respond to other treatments or in cases that involve large sections of the diseased blood vessel. A section of healthy vein is taken from somewhere else in the body and surgically grafted to re-route blood flow around the blockage in the affected blood vessel. A surgeon may sometimes use a piece of synthetic tubing to detour blood flow.