Peripheral vascular disease

There are certain factors that cause damage to all blood vessels, including those vessels supplying the legs, the heart, the brain, and the kidneys.

Smoking is the most significant risk factor for this condition. Some medical issues can affect blood vessels over time, including diabetes Type 1 and Type 2, high cholesterol, and high blood pressure. Obesity and heart disease, or any close family member with heart disease, also add to your risk.

You are at higher risk as you age, especially those over 50 years old, which is more common in men and post-menopausal women.

Uncontrolled and untreated PVD can increase your chance of developing coronary artery disease (CAD), which can cause heart attacks, and critical limb ischemia, which requires urgent medical attention to avoid amputation.

The classic symptom of PVD is pain in the calves or lower legs that comes on with walking or exercise. This can be mild or severe depending on the degree of CVD involved, and is often described as a burning or cramping type of pain. Walking uphill can bring this pain on more quickly than walking on a flat surface, and resting for a few minutes causes the pain to settle away. This is known as intermittent claudication. In severe cases this pain may start to happen at rest without any activity being involved.

There may also be cooling of the feet, poor hair growth below the knees or weak pulses in the feet that are difficult to feel.

Your doctor will ask about your symptoms and go through any risk factors with you. They may have a look at your legs and listen to your heart, and they’ll take your blood pressure.

You may be sent for blood tests to check your cholesterol and sugar levels for diabetes. Doppler ultrasounds assess the blood flow in the veins, and they can measure the blood pressure of the arteries in each leg using an ankle brachial pressure index (ABPI). They may refer you for further investigations to examine the pressure and blood flow in your vessels.

You may be sent for an angiogram, where a contrast dye is injected into an artery, and x-ray images are taken to identify any blockages.

To understand how your symptoms are affected by activity, you may be asked to do a treadmill test, where you walk on a treadmill while your doctor assesses your circulation.

The first thing is to address the risk factors you can do something about, such as stopping smoking and losing excess weight. You can change your diet and exercise level to help improve any diabetes, high blood pressure, or high cholesterol. Your doctor may prescribe medications for this.

Sometimes medication to thin your blood may be offered, such as aspirin, to prevent a blood clot from forming.

Cilostazol is another medication that can sometimes be used to improve blood flow if you have leg pain on walking.

Surgery may be required to restore the blood flow, and this is dependent on the severity of your symptoms and the findings of the investigations. During an angioplasty, a small balloon is inflated inside the vessel to keep it open. An artery bypass graft uses an artery from elsewhere in the body to create a bridge to bypass the blockage.