Article by Dr Manasa S, B.A.M.S
Peripheral vascular disease (PVD) refers to any disease or disorder affecting the circulatory system outside of the brain and heart, often synonymous with peripheral artery disease.
It is the most common disease of the arteries, primarily caused by atherosclerosis – a gradual buildup of fatty material inside the vessels, leading to blockages, narrowing, or weakening of arteries. While atherosclerosis is often associated with heart and brain arteries, it can affect any blood vessel in the body, with the legs being the most commonly impacted.
Currently, approximately 8.5 million people in the United States are affected by PVD, with 12% to 20% of individuals over age 60 experiencing this condition. It is particularly prevalent among those with diabetes and individuals who smoke, with the combination of these factors often resulting in more severe disease.
Understanding PVD is crucial, as many affected individuals may not display symptoms until the condition has progressed. Studies suggest that up to 40% of people with PVD are asymptomatic.
Early signs include pain during walking (claudication) and persistent leg wounds. If left undiagnosed and untreated, PVD can lead to severe complications, such as gangrene requiring amputation, and life-threatening events like heart attacks and strokes.
Public awareness of the risk factors—such as smoking, high cholesterol, high blood pressure, and poor blood sugar control—is essential for prevention. Recognizing early symptoms and seeking timely medical evaluation can significantly improve quality of life, reduce the risk of complications, and enhance longevity for individuals with PVD.
Causes of Peripheral Vascular Disease (PVD)
Peripheral Vascular Disease (PVD) is primarily caused by the narrowing or blockage of blood vessels outside the heart, especially in the limbs. The most common underlying condition that leads to PVD is atherosclerosis, a process where fatty deposits accumulate in the walls of the arteries, restricting blood flow.
Key causes of PVD include:
Atherosclerosis: The build-up of fatty substances, calcium, and scar tissue within the arteries forms plaques, which restrict or block blood flow, leading to PVD.
Blood Clots: A blood clot can obstruct the flow of blood in a vessel, leading to acute symptoms of PVD.
Diabetes: Prolonged high blood sugar levels in diabetic patients damage the blood vessels, increasing their likelihood of narrowing and weakening. Diabetes also contributes to high blood pressure and elevated blood fats, which accelerate atherosclerosis.
Inflammation of the Arteries (Arteritis): Conditions like vasculitis can cause inflammation and damage to the arteries, contributing to narrowing or blockages.
Infections: Certain infections, like syphilis and salmonellosis, can cause inflammation, scarring, and damage to blood vessels.
Structural Defects: Some individuals are born with abnormalities in their blood vessels, such as Takayasu arteritis, a disease that affects the aorta and is more common in females of Asian descent.
Injury: Trauma from accidents can damage blood vessels, leading to restricted blood flow and the onset of PVD.
The following conditions may also lead to structural changes in the blood vessels –
– Buerger’s Disease: A rare condition that causes inflammation and thrombosis in small and medium-sized arteries and veins, often leading to blockages.
– Chronic Venous Insufficiency: A condition where the veins in the legs are unable to effectively return blood to the heart, causing blood pooling and vessel damage. Chronic Venous Insufficiency is one of the causes of PVD.
– Deep Vein Thrombosis (DVT): The formation of a blood clot in a deep vein, typically in the legs, which can obstruct blood flow and damage the vessel walls.
– Raynaud’s Disease: A disorder that causes the blood vessels in the extremities to constrict in response to cold or stress, potentially leading to long-term vessel damage.
– Thrombophlebitis: Inflammation of a vein, often due to a blood clot, which can cause swelling and impair normal blood flow.
– Varicose Veins: Enlarged, twisted veins caused by weakened valves, leading to poor circulation and structural changes in the affected vessels.
Risk Factors for Peripheral Vascular Disease (PVD)
Several risk factors can increase the likelihood of developing PVD. These include both lifestyle factors and underlying health conditions:
Family History: A family history of heart disease, stroke, high blood pressure, or high cholesterol increases the risk of PVD.
Age: Individuals over the age of 50 are at a higher risk of developing PVD due to the natural wear and tear on blood vessels.
Overweight or Obesity: Excess weight puts additional strain on blood vessels, contributing to conditions like atherosclerosis.
Sedentary Lifestyle: Lack of physical activity can exacerbate poor circulation and increase the risk of plaque build-up in the arteries.
Smoking: Smoking damages the blood vessels and accelerates the development of atherosclerosis, significantly increasing the risk of PVD.
Diabetes: People with diabetes are at greater risk for developing PVD due to the vascular damage caused by prolonged high blood sugar levels.
High Blood Pressure: Hypertension weakens the arteries and increases the risk of blood vessel damage, which can contribute to PVD.
High Cholesterol: Elevated levels of LDL (“bad” cholesterol), high triglycerides, and low HDL (“good” cholesterol) can lead to the formation of arterial plaques, increasing the likelihood of PVD.
History of Heart Disease or Stroke: Individuals with coronary artery disease or those who have experienced a heart attack or stroke are at a higher risk of also having PVD.
Proper management of these risk factors, through lifestyle changes or medical intervention, can significantly reduce the likelihood of developing or worsening PVD.
Symptoms of Peripheral Vascular Disease (PVD)
Peripheral Vascular Disease (PVD) often presents subtly, with only about 60% of individuals showing noticeable symptoms. These symptoms typically arise from restricted blood flow to the muscles, especially in the legs, leading to discomfort and pain. The extent and location of the artery blockage determine the severity and type of symptoms experienced.
The most common symptom is intermittent claudication, a pain that comes and goes, typically in the calves, thighs, or hips. This pain often occurs during physical activities like walking or climbing stairs and subsides with rest. It may manifest as:
– Dull, cramping pain in the muscles
– Heaviness, tightness, or tiredness in the legs
– Leg pain at night when blood vessels are severely blocked
Other notable symptoms of PVD include –
– Pain in the buttocks
– Numbness, tingling, or weakness in the legs
– Burning or aching in the feet or toes while at rest
– Non-healing sores on the legs or feet
– Legs or feet feeling cold or changing color (pale, bluish, or reddish)
– Loss of hair on the legs
– Impotence
These symptoms, particularly if experienced at rest, indicate a more severe progression of the disease.
Emergency Signs and When to Seek Medical Care
While PVD generally progresses slowly and is not an immediate medical emergency, certain symptoms should prompt an urgent evaluation by a healthcare provider.
Emergency Care in Peripheral Vascular Disease (PVD)
While Peripheral Vascular Disease (PVD) itself is not typically considered an immediate medical emergency, its symptoms should never be ignored. Early evaluation and treatment are crucial to prevent progression and avoid severe complications like heart attacks, strokes, or limb amputations.
If you experience persistent symptoms such as pain, numbness, or non-healing sores in a leg, foot, arm, or hand, consult your healthcare provider promptly for an evaluation. Effective management can help reduce the risk of more serious cardiovascular events.
However, if PVD symptoms are accompanied by any of the following emergency signs, seek immediate medical attention by calling emergency healthcare numbers
– Chest pain or discomfort in the upper back, neck, jaw, or shoulder
– Fainting or sudden loss of consciousness
– Sudden numbness, weakness, or paralysis in the face, arm, or leg, especially on one side of the body
– Sudden confusion or difficulty speaking or understanding
– Vision loss or sudden trouble seeing in one or both eyes
– Dizziness, difficulty walking, loss of balance, or coordination
– Severe headache with no known cause
These symptoms may indicate a serious complication such as a heart attack, stroke, or other vascular emergency. Prompt medical intervention is vital to prevent life-threatening outcomes.
Early diagnosis and management of PVD can prevent further complications like heart attacks, strokes, or limb amputation. Recognizing symptoms and seeking timely care can significantly improve outcomes and quality of life.
Diagnosis of Peripheral Vascular Disease (PVD)
Early diagnosis of Peripheral Vascular Disease (PVD) is crucial to prevent severe complications and improve the overall prognosis. If a person suspects they may have PVD, seeking medical advice promptly is essential. A doctor will typically begin with a thorough evaluation, including:
– Medical and Family History: The doctor will inquire about lifestyle factors, diet, medication use, and any family history of heart disease, high blood pressure, or cholesterol.
– Physical Examination: This includes checking the temperature and appearance of the skin, especially in the legs and feet, and assessing the presence of a pulse in these areas.
To confirm the diagnosis or rule out other conditions that may mimic PVD, the doctor may order several diagnostic tests.
Common Diagnostic Tests for PVD
Ankle-Brachial Index (ABI) – A non-invasive test that measures blood pressure in the ankles and compares it to the blood pressure in the arms. Differences in blood pressure readings, especially lower pressure in the legs, may indicate blocked or narrowed arteries.
Blood Tests – Although not definitive for diagnosing PVD, blood tests can help identify underlying conditions such as diabetes or high cholesterol that increase the risk of developing PVD.
Angiography – This test involves injecting dye into the arteries to visualize blockages or narrowed areas. It provides a clear picture of the artery structure and the location of any obstructions.
Treadmill Exercise Test – During this test, the patient walks on a treadmill while the speed and incline are gradually increased. If the patient experiences leg pain at a certain threshold, it may suggest PVD.
Ultrasound – An ultrasound uses sound waves to visualize blood flow in the arteries and veins, helping to identify any blockages or areas of reduced circulation.
Photoplethysmography (PPG) – A non-invasive test where a light source and photodetector are placed on the skin to assess blood circulation. This test monitors variations in blood flow and heart rate.
Computed Tomography Angiography (CTA) – This imaging technique provides a detailed view of the blood vessels, showing areas of narrowing or blockage.
Magnetic Resonance Angiography (MRA) – Similar to CTA, MRA uses magnetic fields and radio waves to create images of the blood vessels, highlighting any obstructions.
Pulse Volume Recording (PVR) – PVR measures changes in blood volume in the legs during the cardiac cycle. Reductions in pulsatility can indicate blockages, and this test is often combined with Doppler ultrasound to assess leg arteries.
The combination of a detailed medical history, physical examination, and various diagnostic tests helps physicians accurately diagnose PVD, allowing for early intervention and management to reduce complications and improve patient outcomes.
Complications of Peripheral Vascular Disease (PVD)
If left undiagnosed or untreated, Peripheral Vascular Disease (PVD) can lead to severe and potentially life-threatening complications. These include:
– Gangrene (tissue death): Reduced blood flow can cause tissue to die, leading to gangrene, which may require the amputation of the affected limb.
– Severe Pain: PVD can cause chronic pain, particularly in the legs, which can significantly restrict mobility and daily activities.
– Slow-Healing Wounds: Poor circulation in the limbs can result in ulcers and wounds that are slow to heal, increasing the risk of infection.
– Infections: PVD can lead to serious infections of the bones (osteomyelitis) or the bloodstream (sepsis), both of which can be fatal if not treated promptly.
Management and Treatment for Peripheral Vascular Disease (PVD)
Interventional Procedures
Angioplasty: This non-surgical procedure widens blocked or narrowed arteries. A diagnostic angiogram locates the blockage, and if severe, angioplasty is performed using a catheter with a small balloon that inflates to widen the artery.
Stenting: In severe cases or when the artery narrows again post-angioplasty, a stent (metal mesh sleeve) is placed to keep the artery open. Drug-eluting stents help reduce scar tissue formation.
Atherectomy: This involves the removal of atherosclerotic plaque using a tiny cutting blade within the artery.
Medications
Medications are used to address PVD’s underlying causes and symptoms:
– Cilostazol (Pletal): Prevents platelets from clumping and helps dilate blood vessels, improving circulation.
– Antiplatelet agents: These include aspirin and clopidogrel, used to prevent blood clots and reduce the risk of heart attack and stroke.
– Pentoxifylline (Trental): Improves blood flow by making blood cells more flexible.
– Cholesterol-lowering drugs: Essential to prevent the progression of atherosclerosis.
Surgery
In severe cases, a bypass surgery may be needed. A vein or synthetic artery is used to bypass the obstructed section, restoring blood flow. However, surgery is now less common due to advancements in medications and interventional techniques.
Next Steps
Follow your healthcare provider’s recommendations, take prescribed medications as directed, and report any symptom changes or side effects. Regular follow-up ensures optimal management of PVD.
Prevention of Peripheral Vascular Disease (PVD)
Preventing PVD involves adopting lifestyle changes that not only lower the risk of PVD but also reduce the likelihood of developing other chronic diseases. Key preventive measures include:
– Quit Smoking: Smoking is a major risk factor for PVD. Quitting smoking or avoiding it altogether is one of the most effective ways to protect vascular health.
– Regular Physical Activity: Engage in daily exercise such as walking, cycling, yoga, or gym activities to promote healthy blood circulation and maintain cardiovascular health.
– Balanced Diet: A nutritious diet rich in whole foods, including fruits, vegetables, whole grains, and lean proteins, helps manage weight, cholesterol, and blood pressure.
– Maintain a Healthy Weight: Achieving and maintaining a moderate body weight reduces strain on the vascular system and lowers the risk of atherosclerosis.
– Manage Blood Sugar, Cholesterol, and Blood Pressure: Regular monitoring and management of blood sugar, cholesterol, and blood pressure levels are crucial in preventing PVD, especially for those with diabetes or hypertension.
By adopting these preventive behaviors, individuals can significantly reduce their risk of developing PVD and enhance their overall cardiovascular health.
ABI – Ankle Brachial Index – Measurement of ABI is considered as an effective non-invasive objective measure for the diagnosis of Peripheral Arterial Disease, which is a part of PVD. Normal ratio ranges between 0.9 to 1.2. Values less than 0.9 are diagnostic of Peripheral Arterial Disease. If the values are abnormally high (ratios), the individuals will have higher all-cause mortality compared to normal ABI ratios.
Smoking – increases the risk of developing Peripheral Arterial Disease four times in comparison to non-smokers. It has the greatest impact on the severity of the disease. Smoking reduces the life spans and the disease progresses frequently to a state of critical limb ischemia and amputation.
Gene Therapy – is one of the recent advances in the treatment approach of PADs. The aim of this therapy is to stimulate the growth of new blood vessels in the affected areas. This procedure is called angiogenesis. It aims to improve blood flow and tissue healing in these patients.
Yoga / Asanas for PVD
Some effective Yoga poses for those suffering from PVD and PAD (peripheral arterial disease) are –
– Adho Mukha Shvanasana – Downward facing dog pose
– Gomukhasana – Cow Face Pose
– Dandasana – Staff pose
– Virabhadrasana II – Warrior II Pose
– Trikonasana – Triangle Pose
Peripheral Vascular Disease (PVD): Ayurveda Understanding
Seeing the symptoms of Peripheral Vascular Disease, it can be clearly put under the spectrum of ‘VATARAKTA’ or Vatashonita disease explained in Ayurveda. Most symptoms of Vatarakta including Uttana Vatarakta – Vatarakta manifesting in superficial tissues (skin and muscles), Gambhira Vatarakta – Vatarakta seated in deeper tissues and most symptoms of Vataja and Raktaja Vatarakta and some symptoms of Pittaja and Kaphaja Vatarakta are similar to the symptoms of PVDs. Many complications mentioned in PVDs are also similar to those of Vatarakta. Some premonitory symptoms of Vatarakta are counted amongst the symptoms of PVDs.
Related Reading – ‘Peripheral Vascular Disease v/s Vatarakta’
There are various other perspectives to look at PVDs through the lens of Ayurveda.
PVDs can be considered as diseases of siras and dhamanis.
The mechanism behind PVD and the chief cause i.e. atherosclerosis closely fits into the description of medasavrita marga and sira granthi.
A peep into the below mentioned concepts would give a broader idea of understanding PVDs through the lens of Ayurveda. This will also give us insights to plan the Ayurveda treatments and medicines for PVDs. They are –
– Raktapradoshaja Rogas
– Medo Roga
– Prameha
– Santarpanottha Rogas with special reference to Prameha and Vatarakta
– Rakta Vriddhi
– Raktapitta
– Rakta Kshaya
Treatment of Peripheral Vascular Diseases should be on the lines of the treatment principles of Vatarakta or any of the other conditions mentioned above, as and where they fit into.
Related Reading – ‘Peripheral Vascular Diseases – Ayurveda Understanding’
