Peripheral Vascular Disease (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Daniel Lee Kulick, MD, FACC, FSCAI
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
In this Article
- Peripheral vascular disease (PVD) definition and facts
- What is peripheral vascular disease (PVD)?
- Are atherosclerosis and peripheral vascular disease related?
- What are the signs and symptoms of peripheral artery disease (PVD)?
- Who is at risk for peripheral artery disease (PVD)?
- How does atherosclerosis cause disease?
- What are the other causes of peripheral vascular diseases?
- Is there a test to diagnose peripheral artery disease (PVD)?
- What are the management and treatment guidelines for peripheral vascualr disease (PVD)?
- Medications to treat peripheral vascular disease (PVD)
- Angioplasty to treat peripheral vascular disease (PVD)
- Surgery to treat peripheral vascular disease (PVD)
- Which specialties of doctors treat peripheral vascular disease (PVD)?
- What are potential complications of peripheral artery disease (PVD)?
- How can I prevent from getting peripheral vascular disease (PVD)?
- Find a local Cardiologist in your town
How does atherosclerosis cause disease?
There are two ways atherosclerosis causes disease; 1) atherosclerosis can limit the ability of the narrowed arteries to increase delivery of blood and oxygen to tissues during periods of increased oxygen demand such as during exertion, or 2) complete obstruction of an artery by a thrombus or embolus (thrombus and embolus are forms of blood clots; see below) resulting in tissue necrosis (death of tissue). Exertional angina and intermittent claudication are two examples of insufficient delivery of blood and oxygen to meet tissue demand; whereas strokes and heart attacks are examples of death of tissue caused by complete artery obstruction by blood clots.
There are many similarities between coronary artery diseases (atherosclerosis involving the arteries of the heart) and peripheral artery disease, and the two conditions may coexist in the same individual. For example, patients with exertional angina typically have no symptoms at rest. But during exertion the critically narrowed coronary arteries are incapable of increasing blood and oxygen delivery to meet the increased oxygen needs of the heart muscles. Lack of blood and oxygen causes chest pain (exertional angina). Exertional angina typically subsides when the patient rests. In patients with intermittent claudication, the narrowed arteries in the lower extremities (for example, a narrowed artery at the groin) cannot increase blood and oxygen delivery to the calf muscles during walking. These patients experience pain in the calf muscles that will only subside after resting.
Patients with unstable angina have critically narrowed coronary arteries that cannot deliver enough blood and oxygen to the heart muscle even at rest. These patients have chest pain at rest and are at imminent risk of developing heart attacks. Patients with severe artery occlusion in the legs can develop rest pain (usually in the feet). Rest pain represents such severe occlusion that there is insufficient blood supply to the feet even at rest. They are at risk of developing foot ulcers and gangrene.
When the arteries are narrowed as a result of atherosclerosis, blood tends to clot in the narrowed areas, forming a so-called thrombus (plural thrombi). Sometimes pieces of the thrombi break off and travel in the bloodstream until they are trapped in a narrower point in the artery beyond which they cannot pass. A thrombus or piece of thrombus that travels to another point is called an embolus. Thrombi and emboli can cause sudden and complete artery blockage, leading to tissue necrosis (death of tissue due to lack of oxygen).
For example, complete blockage of a coronary artery by a thrombus causes heart attack, while complete blockage of a carotid or cerebral artery causes ischemic stroke. Emboli originating from atherosclerosis in the aorta (the main artery delivering blood to the body) can obstruct small arteries in the feet, resulting in painful and blue (cyanotic) toes, foot ulcers, and even gangrene.
What are collateral vessels or collateral circulation?
Sometimes, despite the presence of a severe blockage in an artery, the involved area does not become painful or lose its blood supply due to the presence of collateral vessels. Collateral circulation means that the particular area is supplied by more than one artery, so that that blockage of a single vessel does not result in a severe degree of blood loss. Collateral circulation can develop over time to help provide oxygenated blood to an area where an artery is narrowed. Doctors believe that regular supervised exercise can stimulate the growth and development of collateral circulation and relieve symptoms of intermittent claudication.
What are the other causes of peripheral vascular diseases (PVD)?
A number of conditions such as vasculitis (inflammation of the blood vessels, occurring either as a primary condition or associated with connective tissue diseases such as lupus) may cause damage to blood vessels throughout the body. Injuries to blood vessels (from accidents such as auto accidents or sports injuries), blood-clotting disorders, and damage to blood vessels during surgery can also lead to inadequate blood supply to body tissues (ischemia).
Tissue ischemia can also occur in the absence of atherosclerosis or other abnormalities of arteries. One example of a condition in which the blood vessels themselves are not damaged is Raynaud's disease, which is believed to occur due to spasms in blood vessels brought on by stress or a cold environment.
Since atherosclerosis of the peripheral arteries (PAD) is by far the most common cause of peripheral vascular disease, the rest of this article focuses upon peripheral artery disease.
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