Peripheral Vascular Disease (PVD)

Affecting approximately 1.5-2 million people in the United States, peripheral vascular disease ( PVD) is a circulatory disorder characterized by narrowing of the blood vessels, usually in the legs. Twenty percent of adults over 70 have PVD

This condition is typically caused by arteriosclerosis, a buildup of plaque (fatty substances along the inner wall of the arteries), the same process that causes blockages in the arteries of the heart. Peripheral arterial disease is associated with an increased risk of heart attack.

Risk factors for PVD include:

• Smoking - smokers have a 3-fold increased risk for PVD
• High cholesterol
• Diabetes
• High blood pressure
• Age (usually 50 and older)
• Those with a history of heart, carotid disease, or stroke
• A sedentary lifestyle (physical activity)

Symptoms of PVD vary, depending on the affected area, but may include:

• Claudication - cramping or fatigue in the legs while walking, which disappears after a few minutes of rest.
• Pain in the feet while in bed
• Slow healing or non-healing sores on the feet or legs
• Numbness, tingling, or coldness in the lower legs or feet

Diagnosis:

The first step in diagnosing PVD is thorough history and physical examination by your physician, including an examination of pulses and any sores on the legs or feet.

Non-Invasive Testing at Anaheim Regional includes:

• Ankle brachial index:
  • Uses blood pressure cuffs and a handheld doppler device to determine the blood pressure at the ankle and in the arms. If the blood pressure in the lower part of your leg is lower than the pressure in your arm, you may have PVD
• Arterial Duplex
  • A noninvasive ultrasound test to look for areas of narrowing or blockage in the arteries of the legs and pelvis
• CT angiography
  • A state of the art CT scanner is used to determine if there are areas of narrowing or blockage in the arteries. This test involves x-rays and the injection of dye into the veins, which is used to visualize the arteries. Arteries throughout the body can be examined using this test.
• Digital subtraction angiography (DSA)
  • DSA is the "gold standard" to diagnose, and often to treat vascular disease. It involves getting detailed x-ray images of the arteries while injecting dye directly into the arteries. For patients with poor kidney function, a non-toxic gas carbon dioxide can be used in place of IV dye. Blockages can often be opened minimally invasively during an angiogram.

Treatment

• Medical: Most people who have cramping or pain with walking can be treated medically to relieve symptoms and reduce the risk of heart attack by measures such as smoking cessation, exercise, and drug therapy

• Interventional: People who have cramping or pain that significantly affects their daily life, or those with non-healing sores or gangrene may require intervention. The goal of intervention is to relieve symptoms, allow for healing, and reduce the risk of amputation by improving blood flow. The Advanced Endovascular Institute seeks to achieve optimal outcomes using minimally invasive techniques involving lower risks, minimal discomfort, and shorter hospitalizations than traditional open surgical approaches.
  Minimally invasive angioplasty and stenting can usually be done as an outpatient or with a short hospitalization. It is less invasive and less painful than open surgery. However, it may also be less durable than open surgery

Surgical bypass involves using vein or artificial conduit to "bypass" blood flow around areas of blockage and restore more normal circulation. It is significantly more invasive than angioplasty and stenting, requiring a longer hospital stay and recovery period, but may be more durable over the long term.

The specialists of the Endovascular Institute are trained in both angioplasty techniques as well as open surgery, and customize treatment to each patient.