Peripheral Vascular Disease
What is peripheral vascular disease (PVD)?
The term peripheral vascular disease (PVD) refers to diseases of blood vessels outside the heart and brain. Diseases that cause PVD result in a narrowing of the vessels that carry blood to the legs, arms and organs such as the kidneys and bowels. Narrowing of these blood vessels results in insufficient blood flow to the limb or organ preventing normal function.
What are the symptoms of PVD?
In the legs, PVD leads to symptoms such as pain with walking, weakness or the sensation of the foot or leg "going to sleep." As the disease progresses, pain can occur at rest or at night while in bed. Also, minor wounds on the foot or calf may not heal and progress to ulcers that can become infected. PVD can result in decreased activity which can lead to depression and may make other health problems such as heart disease worse. In the arms, PVD can cause arm weakness and can lead to dizziness with exertion. When there is narrowing in the arteries to the kidneys hypertension and renal failure may develop.
What causes PVD?
The most common cause of peripheral vascular disease is atherosclerosis. This is a progressive disease that starts as thickening of the wall of the artery especially at branch points. The process continues over decades
leading to cholesterol and smooth muscle build up that results in narrowing of the artery. The process can even continue until there is complete blockage of the artery. If the artery involved is in the heart, this may result in a heart attack. If disease involves arteries in the neck or brain it may lead to stroke. Atherosclerosis rarely occurs in just one area. When it occurs in the leg there is usually some build up in other arteries such as the heart. The key to treatment is to control risk factors such as hypertension and diabetes and to improve blood flow through angioplasty or bypass.
What are the risk factors for PVD?
Smoking, hypertension, diabetes, elevated cholesterol levels, obesity and inactivity all increase the risk for atherosclerosis. Evidence of atherosclerosis elsewhere in the body which may present as a heart attack or stroke is associated with a high prevalence of PVD.
How is PVD diagnosed?
A physical exam with your doctor will frequently detect the problem. Screening tests include vascular ultrasound, MRI and CT scan depending on the location of the problem and severity of the symptoms. These tests have very little to no patient risk and are very good at establishing the presence or absence of significant disease.
How is PVD treated?
Treatment is directed at controlling risk factors such as hypertension, tobacco use and diabetes. Exercise programs and diet modification may also play an important role. When this is ineffective or the disease has progressed too far then it may be necessary to provide better blood flow to the area through intervention. This may be done by opening the narrowing in the artery using angioplasty and/or stent placement or bypassing the diseased segment using surgical techniques. Arteriography is usually performed to determine which technique is most appropriate to improve the blood flow.
How is arteriography performed?
Arteriography, sometimes called angiography, is performed by the interventional radiologist in the radiology department. Sedation given through a vein in the arm is used to make the patient comfortable during the procedure. A small tube is placed into the artery in the groin without a surgical incision. X-ray contrast is injected into the area of interest and pictures are taken to assess for blockages in the arteries. If the narrowing or blockages can be treated with angioplasty or stent placement, this is usually performed at the same time. If a surgical bypass is needed, the arteriogram acts as a roadmap to the surgeon who will perform the bypass in the operating room at a later date.
What is angioplasty and stent placement?
Angioplasty is the use of a balloon catheter to open narrowed or blocked segments of an artery. If the angioplasty is ineffective in restoring good blood flow through the diseased segment, then a small metal barrel called a stent is placed in the narrowed segment to keep it open. These procedures have been widely used by interventional radiologists for over twenty years and have been very effective. Angioplasty and stent placement can be performed at the time of arteriography. The procedure is usually performed on an outpatient basis.
How do I schedule an appointment?
Our physicians offer a variety of services for patients with vascular disease including vascular imaging with ultrasound, CT and MRI scanning. The Interventional Radiology section offers the full spectrum of
image-guided vascular care including the vascular radiology clinic, pre-procedure consultation, post-procedure care and when necessary, hospital admission. All patients can schedule an office visit to consult with a radiologist to discuss vascular options prior to performing any procedure. To schedule an appointment or if you have questions concerning this exam, please call the Interventional Radiology Clinic at 704-786-0052.
