What is peripheral vascular disease?

Peripheral vascular disease is a type of atherosclerosis, a hardening and narrowing of the arteries that supply blood to the arms and legs. In most cases, it affects the legs. When the problem becomes severe, leg pain develops. Leg bypass surgery or even amputation may become necessary.

How does it occur?

The narrowing of the inside of the arteries occurs when deposits of cholesterol and calcium develop over time on the inner artery walls. These deposits are called plaques. The plaques may eventually become so thick that they completely block the flow of blood through the arteries.

Several factors can put you at risk for developing peripheral vascular disease. Production of the plaques in your arteries may result from:

• an inherited (genetic) tendency in your family

• diabetes

• high levels of blood fat (for example, cholesterol)

• high blood pressure

• cigarette smoking.

What are the symptoms?

The disease progresses silently, without symptoms, until the arteries have become significantly narrowed.

The first symptom is usually pain in the calf muscles when you walk or exercise your legs. As the narrowing worsens, the pain worsens. Pain may be felt in the thighs and buttocks if the narrowing is in the arteries leading to the thighs. One or both legs may be affected. This pain typically occurs with exertion, quickly goes away when you rest, and then comes back when you are active again.

You feet may seem cooler. If you previously had hair on the tops of your feet, you may notice some hair loss. Cuts and scrapes may take longer to heal.

How is it diagnosed?

Your doctor will examine you and ask about your symptoms and your personal and family medical history. He or she will check the pulses in your feet, legs, and groin.

To identify the location and degree of arterial narrowing, you may have an angiogram or Doppler (sound wave) test.

How is it treated?

The first important step of treatment is to manage any risk factors. For example you might need to:

• Stop smoking.

• If you are diabetic, control your blood sugar.

• Reduce your blood pressure.

• Lower the level of fats in your blood.

Changes in your diet may be necessary. A diet high in complex carbohydrates (whole grains, pastas), fresh fruits, vegetables, and fiber, and low in salt, animal fats, and refined sugar is healthy for nearly everyone. It is especially important in the treatment of diabetes, hypertension, lipid (blood fat) disorders, and vascular disease.

If you are a smoker, you must stop smoking. One of nicotine's effects is vasoconstriction. This means the nicotine temporarily narrows the arteries. Each cigarette you smoke decreases blood flow as the inhaled nicotine circulates in your blood.

Your doctor may need to adjust or change the medications you are taking. Some dosages or drugs restrict blood flow less than others. Your doctor may prescribe new medication to try to improve blood flow.

Exercise is vital to improving and maintaining good circulation in your arteries. Your doctor may recommend an exercise program for you. However, you may need to have surgery first.

Your doctor may recommend surgery for significant blockages. During surgery the blocked area may be removed and replaced with a piece of your own vein (removed from another part of your body). The replacement is called a graft. Sometimes synthetic material instead of a vein is used for the graft. Abdominal surgery may be necessary to repair blockages in the arteries that flow into the legs.

In some cases other techniques are available that allow blockages in the peripheral arteries to be treated through catheterization and balloon dilatation, thus avoiding surgery. In catheterization a small tube is inserted in an artery in the groin; it allows your doctor to see blockages. The blockages can then possibly be treated by inflating a balloon at the tip of the catheter to widen the blocked area of the artery.

If your disease is extremely severe or other health problems prevent surgery, amputation of your foot or leg may become necessary. Amputation is usually necessary if you have so little blood flow that the skin and other tissues die and you become susceptible to life-threatening infection. Amputation is a last resort, but if peripheral vascular disease is not controlled, it is a possible complication.

How long will the effects last?

Peripheral vascular disease is a disease that you will continue to have and that will get worse unless you receive treatment.

How can I take care of myself?

• Follow your doctor's instructions on diet, exercise, and medication.

• If you are a smoker, stop smoking.

• Take care not to injure the affected leg. Injuries to that leg will heal much more slowly. Proper shoes, safe terrain, and safe exercise equipment are important.

• See a doctor immediately if your symptoms suddenly become more severe. The worsened symptoms could indicate a complete blockage.

What can I do to help prevent peripheral vascular disease?

The best way to try to prevent peripheral vascular disease is to maintain all-around fitness. Try to reach and keep a normal weight, normal blood pressure, and normal levels of lipids and sugar in your blood. Eat a diet low in fat and refined sugar, and high in complex carbohydrates and fiber. Exercise three to four times a week, striving to walk 20 or more minutes each time, or according to your doctor's prescription. Exercycling and swimming are good alternatives to walking, but you should consult with your doctor before you start a more vigorous program.