Peripheral Vascular Disease
An estimated 10 million Americans, most over age 50, suffer from peripheral vascular disease, or narrowing of peripheral (i.e., outside of the heart and brain) blood vessels or arteries (the latter is a subtype of PVD known as peripheral artery disease, or PAD). This narrowing reduces blood flow, depriving tissue and organs of oxygen and potentially causing tissue death. Symptoms of PVD most often occur in the legs and feet, resulting in pain, numbness, and other problems.
Over time, high blood sugars can cause blood vessel narrowing, and so can high cholesterol levels. High cholesterol can leave fatty deposits in the blood vessels (arteriosclerosis); sometimes these fatty deposits harden or combine with calcium deposits (creating plaques) and "hardening of the arteries" (arteriosclerosis) is the result.
Other potential causes include blood clots, inflammation of the arteries (vasculitis), infection, and traumatic injury to blood vessels.
The primary symptom of PVD is pain in the buttocks, calves, and/or thighs (and less commonly, in the arms), particularly when standing, walking, or exercising. Other symptoms may include:
- Cold feet and legs
- Numbness in feet and legs
- Bluish or reddish skin coloring on the legs or feet
- Leg wounds that won't heal properly
- Calf and leg cramps when walking (i.e., intermittent claudication)
- A weak or absent pulse in the arms or legs
Treatment and Prevention
In some cases, angioplasty (either with or without stenting) may be recommended to open blocked arteries. Angioplasty is a surgical procedure involving inserting a balloon-tipped catheter into an artery and expanding the balloon at the point of the arterial blockage to try to reopen it. A stent, a tube-shaped device designed to prevent reblockage of the artery, may be placed at the time of the angioplasty.
Another surgical option for PVD is an arterial bypass, in which a section of healthy artery (harvested from elsewhere in the patient's body) is grafted on to the diseased artery to bypass the blockage and shuttle blood around it. In some cases, a surgery may use a piece of synthetically produced artery for the bypass.
Pentoxifylline (Trental) and cilostazol (Pletal) are two medications that have been approved for the treatment of intermittent claudication by the U.S. Food and Drug Administration. Other drugs used to treat PVD by improving blood flow include antiplatelet drugs (e.g., aspirin), anticoagulants (e.g., warfarin), and thrombolytics. Thrombolytic drugs, also known as "clot busters," are only administered in a hospital setting.
To prevent PVD, patients with diabetes should focus on the basics for good diabetes control and heart health — controlling blood glucose and cholesterol levels, quitting smoking, maintaining good nutrition and exercise habits, and keeping blood pressure in a safe range.
Reviewed by Francine Kaufman, MD. 4/08
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