Peripheral Vascular Disease (PVD) and Exercise

Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart and diseases of the lymph vessels - the arteries, veins, or lymphatic vessels. Organs supplied by these vessels such as the brain, heart, and legs, may not receive adequate blood flow for ordinary function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

Conditions associated with PVD that affect the veins include deep vein thrombosis (DVT), varicose veins, and chronic venous insufficiency. Lymphedema is an example of PVD that affects the lymphatic vessels.

When PVD occurs in the arteries outside the heart, it may be referred to as peripheral arterial disease (PAD). However, the terms "peripheral vascular disease" and "peripheral arterial disease" are often used interchangeably. In the US, about 10 million people have peripheral artery disease. It is frequently found in people with coronary artery disease, because atherosclerosis, which causes coronary artery disease, is a widespread disease of the arteries.

What causes peripheral vascular disease?

PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis (the buildup of plaque inside the artery wall). Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.

Other causes of peripheral vascular disease may include trauma to the arms or legs, irregular anatomy of muscles or ligaments, or infection. Persons with coronary artery (arteries that supply blood to the heart muscle) disease are frequently found to also have peripheral vascular disease. 

By following an aggressive treatment plan for peripheral vascular disease, complications may be prevented.

Prevention of peripheral vascular disease:

Steps to prevent PVD are primarily aimed at management of the risk factors for PVD. A prevention program for PVD may include:

• smoking cessation, including avoidance of second hand smoke and use of tobacco products
• dietary modifications including reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables
• treatment of dyslipidemia (high blood cholesterol levels) with medications as determined by your physician
• weight reduction
• medications as determined by your physician to reduce your risk of blood clot formation
• exercise plan of a minimum of 30 minutes daily
• control of diabetes mellitus
• control of hypertension (high blood pressure)

A prevention plan for PVD may also be used to prevent or lessen the progress of PVD once it has been diagnosed. Consult your physician for diagnosis and treatment.

What are the risk factors for peripheral vascular disease?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history, or many other things. Risk factors for peripheral vascular disease include factors which can be changed or treated and factors that cannot be changed.

Risk factors that cannot be changed include the following:

• age (especially older than 50)
• history of heart disease
• male gender
• diabetes mellitus (type 1 diabetes)
• postmenopausal women
• family history of dyslipidemia (elevated lipids in the blood, such as cholesterol), hypertension, or peripheral vascular disease

Risk factors that may be changed or treated include:

• coronary artery disease
• impaired glucose tolerance
• dyslipidemia
• hypertension (high blood pressure)
• obesity
• physical inactivity
• smoking or use of tobacco products

Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow. 

What are the symptoms of peripheral vascular disease?

Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the clogged or narrowed artery.

Other symptoms of peripheral vascular disease may include:

• changes in the skin, including decreased skin temperature, or thin, brittle shiny skin on the legs and feet
• diminished pulses in the legs and the feet
• gangrene (dead tissue due to lack of blood flow)
• hair loss on the legs
• impotence
• non-healing wounds over pressure points, such as heels or ankles
• numbness, weakness, or heaviness in muscles
• pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
• pallor (paleness) when the legs are elevated
• reddish-blue discoloration of the extremities
• restricted mobility
• severe pain
• thickened, opaque toenails

The symptoms of peripheral vascular disease may resemble other conditions. Consult your physician for a diagnosis. 

What is the treatment for peripheral vascular disease?

There are two main goals for treatment of peripheral artery/vascular disease: control the symptoms and halt the progression of the disease to lower the risk of heart attack, stroke, and other complications. 

Specific treatment will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your signs and symptoms
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• lifestyle modifications to control risk factors, including regular exercise, proper nutrition, and smoking cessation
• aggressive treatment of existing conditions that may aggravate PVD, such as diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol)
• medications for improving blood flow, such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls
• angioplasty - a catheter (long hollow tube) is used to create a larger opening in an artery to increase blood flow. Angioplasty may be performed in many of the arteries in the body. There are several types of angioplasty procedures, including:
  • balloon angioplasty - a small balloon is inflated inside the blocked artery to open the blocked area
  • atherectomy - the blocked area inside the artery is "shaved" away by a
  • tiny device on the end of a catheter (SilverHawk™ Plaque Excision System)
  • laser angioplasty - a laser used to "vaporize" the blockage in the artery
  • stent - a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open
• vascular surgery - a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow

With both angioplasty and vascular surgery, an angiogram is often performed prior to the procedure.