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Peripheral Vascular Disease (PVD)

Peripheral vascular disease (PVD) is when your arteries become narrower and, as a result, less blood flows to your legs and arms. PVD is usually caused by a buildup of fatty deposits in your arteries. When your legs or arms don't receive enough blood flow, this may cause symptoms. For example, your legs might hurt when you walk.

One common type of PVD is peripheral artery disease (PAD), a condition that affects only arteries, and primarily the leg arteries.

What happens once you have peripheral vascular disease (PVD)?

While many people with PVD have mild or no symptoms, some people have leg pain when walking.

This muscle pain or cramping in your legs or arms is triggered by activity like walking, but disappears after a few minutes of rest. The location of the pain depends on the site of the clogged or narrowed artery. Calf pain is the most common location.

The pain ranges from mild discomfort to severe pain that can make it hard to walk or do other types of physical activity.

PVD signs and symptoms include:

  • Shiny skin on your legs.

  • Erectile dysfunction in men.

  • Leg numbness or weakness.

  • Coldness in your lower leg or foot.

  • A change in the color of your legs.

  • Slower growth of your toenails.

  • Sores on your toes, feet, or legs that won't heal.

  • No pulse or a weak pulse in your legs or feet.

  • Hair loss or slower hair growth on your feet and legs.

  • Painful cramping in your hips, thighs, or calf muscles after activities like walking or climbing stairs.

  • Pain when using your arms, such as aching and cramping when knitting, writing, or doing other manual tasks.

Pain may happen even when you're resting. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

What causes PVD?

PVD is often caused by atherosclerosis. In atherosclerosis, fatty deposits build up on your artery walls and reduce blood flow. Less commonly, the cause of PVD may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure.

Factors that increase your risk of developing PVD include:

  • Smoking.

  • Diabetes.

  • High cholesterol.

  • High blood pressure.

  • Obesity (a body mass index over 30).

  • Getting older, especially after age 65.

  • A family history of PVD, heart disease or stroke.

  • High levels of homocysteine, an amino acid that helps your body make protein and to build and maintain tissue.

If your PVD is caused by a buildup of plaque in your blood vessels, you're also at risk of developing:

  • Critical limb ischemia: This condition begins as open sores that don't heal, an injury, or an infection of your feet or legs. When the injuries or infections get worse, they sometimes require amputation of the affected limb.

  • Stroke and heart attack: The atherosclerosis that causes PVD also affect your heart and brain because of reduced blood supply.

What types of tests are used to diagnosis PVD?

Some of the tests your doctor may give you to diagnose PVD are:

  • Physical exam: Your doctor may find signs of PVD during a physical exam, such as a weak or absent pulse below a narrowed area of your artery; whooshing sounds over your arteries that can be heard with a stethoscope; evidence of poor wound healing; and decreased blood pressure in your affected limb.

  • Ankle-brachial index (ABI): This test compares the blood pressure in your ankle with the blood pressure in your arm. Your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to measure how hard your heart has to work during walking.

  • Ultrasound: Special ultrasound imaging techniques, such as Doppler ultrasound, can help your doctor measure blood flow and identify blocked or narrowed arteries.

  • Angiography: Using a dye injected into your blood vessels, this test allows your doctor to view blood flow through your arteries using imaging techniques, such as X-rays, magnetic resonance angiography (MRA) or computerized tomography angiography (CTA).

  • Catheter angiography: This type of angiography involves guiding a small hollow tube (catheter) through an artery in your groin to the affected area and injecting the dye. It allows your doctor to also treat a blocked blood vessel at the time of diagnosis. After finding the narrowed area of a blood vessel, your doctor can then widen it by inserting and expanding a tiny balloon or by administering medication that improves blood flow.

  • Blood tests: A sample of your blood can measure your cholesterol and triglycerides and check for diabetes.

What types of treatments and procedures are used to treat PVD?

Treatment for PVD has two major goals:

  • Manage symptoms.

  • Stop atherosclerosis from getting worse.

If you have signs or symptoms of PVD, you likely will need medical treatment. Luckily, there are many options.

Medications:

  • Cholesterol-lowering medications: You may take a cholesterol-lowering drug called a statin to reduce your heart attack and stroke risk.

  • High blood pressure medications: If you also have high blood pressure, your doctor may prescribe medications to lower it.

  • Medication to control blood sugar: If you have diabetes, controlling your blood sugar levels is important.

  • Blood thinners: Your doctor may prescribe daily aspirin therapy or another medication to improve blood flow.

  • Symptom-relief medications: Drugs that increase blood flow to the limbs by keeping the blood thin and widening the blood vessels are also used as treatment. They specifically help treat leg pain.

Angioplasty and surgery:

  • Balloon angioplasty: In this procedure, a small balloon on the tip of the catheter is inflated to reopen the artery. Your doctor may also insert a mesh tube (stent) in the artery to help keep it open.

  • Bypass surgery: Your doctor may create a path around the blocked artery using either a blood vessel from another part of your body to bypass the blocked or narrowed artery.

  • Thrombolytic therapy: Your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.

Lifestyle changes: Many people can manage the symptoms of PVD and stop the progression of the disease through these lifestyle changes:

  • Stop smoking: Smoking contributes to constriction and damage to your arteries.

  • Exercise: Exercise helps condition your muscles to use oxygen more efficiently.

  • Eat a healthy diet: A heart-healthy diet low in saturated fat and salt can help control your blood pressure and cholesterol levels.

  • Avoid certain cold medications: Over-the-counter cold remedies that contain pseudoephedrine constrict your blood vessels.

What can I do to support my health when I have PVD?

PVD can be frustrating, especially when the exercise that will help you get better causes you pain. Don't get discouraged. As you continue exercising, you'll increase the distance you can walk without pain.

You may find it helpful to raise the head of your bed by four to six inches (10 to 15 centimeters) because keeping your legs below the level of your heart usually lessens pain.

Another tip for reducing your symptoms is to avoid cold temperatures as much as possible. If you can't avoid the cold, be sure to dress in warm layers.

Why choose Presbyterian for PVD treatment?

Presbyterian Heart and Vascular Care has a skilled vascular care team who can provide a wide range of services from diagnosis to treatment. Their surgeons are trained in many different techniques and procedures, many of which can provide you with a shorter recovery period and less hospital time.