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
Is there a test to diagnose peripheral artery disease (PVD)?
During a physical examination, the doctor may look for signs that are indicative of peripheral artery disease, including weak or absent artery pulses in the extremities, specific sounds (called bruits) that can be heard over the arteries with a stethoscope, changes in blood pressure in the limbs at rest and/or during exercise (treadmill test), and skin color and nail changes due to tissue ischemia.
In addition to the history of symptoms and the physical signs of peripheral artery disease described above, doctors can use imaging tests in the diagnosis of peripheral artery disease. These imaging tests include:
- Doppler ultrasound - This form of ultrasound (measurement of high-frequency sound waves that are reflected off of tissues) that can detect and measure blood flow. Doppler ultrasound is used to measure blood pressures behind the knees and at the ankles. In patients with significant peripheral artery disease in the legs, the blood pressures in the ankles will be lower than the blood pressure in the arms (brachial blood pressure). The ankle-brachial index (ABI) is a number derived from dividing the ankle blood pressure by the brachial blood pressure. An ABI of 0.9 to 1.3 is normal, an ABI less than 0.9 indicate the presence of peripheral artery disease in the arteries in the legs, and an ABI below 0.5 usually indicates severe arterial occlusion in the legs.
- Duplex ultrasound - This is a color assisted noninvasive technique to study the arteries. Ultrasound probes can be placed on the skin overlying the arteries and can accurately detect the site of artery stenosis as well as measure the degree of obstruction.
- Angiography - An angiography is an imaging procedure to study the blood vessels of the extremities, similar to the way a coronary angiogram provides an image of the blood vessels supplying the heart. It is the most accurate test to detect the location(s) and severity of artery occlusion, as well as collateral circulations. Small hollow plastic tubes (catheters) are advanced from a small skin puncture at the groin (or the arm), under X-ray guidance, to the aorta and the arteries. Iodine contrast "dye," is then injected into the arteries while an X-ray video is recorded. Angiogram gives the doctor a picture of the location and severity of narrowed artery segments. This information is important in helping the doctor select patients for angioplasty or surgical bypass (see below).
- Because X-ray angiography is invasive with potential side effects (such as injury to blood vessels and contrast dye reactions), it is not used for initial diagnosis of peripheral artery disease. It is only used when a patient with severe peripheral artery disease symptoms is considered for angioplasty or surgery. A number of different imaging methods have been used in angiography examinations, including X-rays, magnetic resonance imaging (MRI), and computed tomography (CT) scans.
- Magnetic resonance imaging (MRI) angiography uses magnetism, radio waves, and a computer to produce images of body structures and has the advantage of avoiding X-ray radiation exposure.
What are the management and treatment guidelines for peripheral vascular disease (PVD)?
Treatment goals for peripheral artery disease include:
- Relieve the pain of intermittent claudication.
- Improve exercise tolerance by increasing the walking distance before the onset of claudication.
- Prevent critical artery occlusion that can lead to foot ulcers, gangrene, and amputation.
- Prevent heart attacks and strokes.
Treatment of peripheral artery disease includes lifestyle measures, supervised exercises, medications, angioplasty, and surgery.
- Smoking cessation eliminates a major risk factor for disease progression and lowers the incidences of rest pain and need for amputations. Smoking cessation is also important for the prevention of heart attacks and strokes.
- A healthy diet can help lower blood cholesterol and other lipid levels and may help control blood pressure.
- Keep other risk factors, such as diabetes, lipid levels, and blood pressure under control by following medical advice regarding medications and lifestyle changes.
Proper exercise can condition the muscles to use oxygen effectively and can speed the development of collateral circulation. Clinical trials have demonstrated that regular supervised exercise can reduce symptoms of intermittent claudication and allow the patients to walk longer before the onset of claudication. Ideally, exercise programs should be prescribed by the doctor. Patients should be enrolled in rehabilitation programs supervised by healthcare professionals such as nurses or physical therapists. For optimal results, patients should exercise at least three times a week, each session lasting longer than 30 to 45 minutes. Exercise usually involves walking on a monitored treadmill until claudication develops; walking time is then gradually increased with each session. Patients are also monitored for the development of chest pain or heart rhythm irregularities during exercise.
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