Peripheral Vascular Disease
Peripheral vascular disease (PVD) involves damage to or blockage in the blood vessels distant from your heartthe peripheral arteries and veins. Your peripheral arteries and veins carry blood to and from your arm and leg muscles and the organs in and below your stomach area. PVD may also affect the arteries leading to your head (see Carotid Artery Disease). When PVD affects only the arteries and not the veins, it is called peripheral arterial disease (PAD). The main forms that PVD may take include blood clots, swelling (inflammation), or narrowing and blockage of the blood vessels. Diseases of the arteries may lead to
- Arterial blockage
- Aortic aneurysms
- Buerger!!!s Disease
- Raynaud!!!s Phenomenon
Disease of the veins may lead to
- Venous blood clots
- Pulmonary embolism
- Varicose veins
Arterial Blockage Much like the coronary arteries, the peripheral arteries can be blocked by plaque. What causes arterial blockage? PVD can result from a condition known as atherosclerosis, where a waxy substance forms inside of the arteries. This substance is called plaque. It is made of cholesterol, fats, calcium, and a blood-clotting material called fibrin. When enough plaque builds up on the inside of an artery, the artery becomes clogged, and blood flow is slowed or stopped. This slowed blood flow may cause ischemia, which means that your body!!!s cells are not getting enough oxygen. While clogged coronary arteries (the arteries that supply your heart with blood) may lead to a heart attack, and clogged carotid arteries (the arteries that supply your head with blood) may lead to a stroke, clogged peripheral arteries in the lower part of the body most often cause pain and cramping in the legs. The risk factors for atherosclerosis in the peripheral arteries are the same as those for atherosclerosis in the coronary arteries. Smoking, diabetes, high blood pressure, and high cholesterol are believed to lead to the development of plaque. What are the symptoms and signs? Patients may feel pain in their calves, thighs, or buttocks, depending on where the blockage is. Usually, the amount of pain you feel is a sign of how severe the blockage is. In serious cases, your toes may turn a bluish color, your feet may be cold, and the pulse in your legs may be weak. In some cases, the tissue dies (this is called gangrene) and amputation may be needed. Sometimes leg cramps develop when a person walks, and the leg pain usually gets worse with increased activity. This cramping is called intermittent claudication. Like the chest pain of angina, the leg pain of intermittent claudication usually goes away with rest. Cold temperatures and some medicines may also cause leg pain. How is an arterial blockage diagnosed? Doctors can make a diagnosis by listening to you describe your symptoms and by checking for a weak pulse in the arteries in your feet. Further tests may include
- Ultrasound, which is a test that uses sound waves to produce an image of blood flow through your arteries.
- Arteriography, which is a test that may be performed if your doctor thinks your condition is serious enough for a transcatheter intervention or surgery. The test uses a harmless dye that is injected into the arteries. It lets doctors see where and how serious the blockage is.
How is a blockage treated? When the blockages are not severe, this form of PVD can be controlled by losing weight, quitting smoking, and following a regular exercise program that has been approved by your doctor. A transcatheter intervention (balloon angioplasty or a peripheral stent) may be needed for a severely blocked artery that is causing pain or other symptoms. Your doctor may also recommend a procedure called a peripheral vascular bypass. This procedure creates a way for blood to flow around one or more of the narrowed vessels. After making an incision in your arm or leg or below your stomach, the surgeon will take an artificial vessel or one of your own veins (called a graft) and connect it to the blocked vessel at points above and below the blockage. This allows blood to flow around, or bypass, the blockage. Aortic Aneurysms An aneurysm is a balloon-like bulge in the wall of a weakened blood vessel. If the bulging stretches the vessel wall too far, the vessel may burst. The aorta is the artery that carries blood from the heart to the rest of the body. An aneurysm in the aorta is called an aortic aneurysm. You can die if an aneurysm causes this main artery to burst and it is not treated in time. An aortic aneurysm may be located in your chest (thoracic aneurysm), but most are located below the kidneys in the lower stomach area (abdominal aneurysms). What causes an aneurysm? Any condition that causes the walls of the arteries to weaken can lead to an aneurysm. Atherosclerosis (a build-up of plaque in the arteries), high blood pressure, and smoking increase your risk. Deep wounds, injuries, or infections can also cause blood vessels to bulge. In some cases, an aneurysm may be a congenital condition, meaning you are born with it. Certain inherited diseases can also increase the risk for developing an aneurysm. For example, an inherited disease called Marfan syndrome, which affects the body!!!s connective tissue, causes people to have long bones and very flexible joints. People with this syndrome often have aneurysms. What are the symptoms? Aortic aneurysms may cause shortness of breath, a croaky or raspy voice, backache, or pain in your left shoulder or between your shoulder blades. An aortic aneurysm in the stomach area may cause pain or tenderness. You may also have an upset stomach or feel less hungry. How are aneurysms detected? Aneurysms can be detected by physical exam, on a basic chest or stomach x-ray, or by using ultrasound. The size and location can be found through echocardiography or radiological imaging, such as arteriography, magnetic resonance imaging (MRI), and computed tomography (CAT or CT) scanning. How are aneurysms treated? Treatment depends on the size and location of your aneurysm and your overall health. Aortic aneurysms in the upper chest (the ascending aorta) are usually operated on right away. Aneurysms in the lower chest or the area below your stomach (the descending thoracic and abdominal parts of the aorta) may not be as life threatening. Aneurysms in these locations are watched for varying periods, depending on their size. If they become about 5 cm (almost 2) in diameter, continue to grow, or begin to cause symptoms, you may need to have surgery to keep the aneurysm from bursting. For aortic aneurysms or aneurysms that happen in the peripheral vessels, surgery involves relining or replacing the weakened section of the aorta with an artificial tube (called a graft). For patients with smaller or stable aneurysms in the descending aorta or abdominal parts of the aortathose farthest from the heartdoctors usually ask patients to come in for regular check-ups so they can follow the growth of the aneurysm. If the aneurysm is not growing, patients may live with it for years. Doctors may also prescribe medicine, especially a medicine like a beta-blocker that lowers blood pressure. Medicines that lower blood pressure relieve the stress on the aortic walls, and they are especially useful when the risk of surgery may be greater than the risk of the aneurysm itself. Buerger!!!s Disease Buerger!!!s disease is related to smoking. The disease causes swelling of the small and medium-sized arteries (and sometimes the veins) in your feet and legs. This rare disorder, which causes the peripheral vessels to tighten or constrict, is more common in men, especially smokers aged 20 to 40. Smoking causes the blood vessels to tighten in everyone who smokes. But in people with Buerger!!!s disease, there is so much tightening in the vessels that a lack of oxygen to the cells (ischemia) or tissue death (necrosis) may result. The symptoms may be different for everyone, but the condition most often causes tender, swollen areas over the vessels, followed by coldness of the feet and hands. Pain in the legs during walking (called intermittent claudication) may happen because of an arterial blockage. The most serious cases sometimes cause the tissue to die, and amputation of the fingers and toes may be needed. People with Buerger!!!s disease must stop smoking completely, and circulation usually improves soon after. Raynaud!!!s Phenomenon Raynaud!!!s phenomenon happens more often in women. It is a circulation disorder that causes the arteries in the fingers and toes to tighten or spasm when they are exposed to cold temperatures, smoking, or emotional stress. Often, the cause of Raynaud!!!s phenomenon is not known. Sometimes, it is a side effect of other conditions, such as connective tissue disease, trauma, or diseases of the glands or central nervous system. People with the disorder may feel numbness or tingling in their fingers and toes. They may also notice that their skin turns pale or blue, followed by reddening in the affected areas. Attacks may last from a few minutes to several hours and are usually treated with gradual warming of the fingers and toes to restore blood flow. Therapy may also include pain relievers, calcium channel blockers, quitting smoking, and avoiding cold temperatures and emotional upset. Venous blood clots Nearly 6 million Americans have a blood clot in their veins (also called venous thrombus, venous thrombosis, or vein thrombosis). When the clot develops in a vein deep within the leg, it is called deep vein thrombosis (DVT). The condition can be life threatening if the clot breaks loose from the vein and travels to the lungs, where it can completely block blood flow. What causes a venous blood clot? Blood clots in the veins are usually caused by slowed blood flow to the legs and feet, which can cause the blood to clot. Venous blood clots may also be caused by damage to a vein from an injury or infection. Blood flow may be slowed because of physical inactivitybeing confined to a bed or having an inactive lifestyle. Some people have slowed blood flow after sitting for a long time, such as on a long plane ride. This is why the condition is sometimes called economy-class syndrome. Other factors that lead to slowed blood flow in the legs and feet include smoking, heart disease, diabetes, high blood pressure, and certain tumors. The use of certain hormones, particularly estrogen, and pregnancy have been shown to increase the risk for blood clots in the legs. Genetic disorders may also increase a person!!!s risk for developing venous blood clots. What are the symptoms of venous blood clots? Blood clots that happen in the veins close to the surface of your skin may cause mild swelling, tenderness, and redness. Symptoms of deep venous clots may include
- Swelling of your ankles or calves.
- Tenderness, swelling, redness, and warmth around the affected area.
- Pain when your foot is raised upward.
How are venous blood clots diagnosed? Doctors can usually tell if you have a venous blood clot by pressing on a part of your leg. If needed, the veins can be viewed by using ultrasound, which uses sound waves to create an image of the vein on a screen. Clots above the knee may be identified by using a blood pressure cuff around your leg to measure blood flow (plethysmography). Deep venous blood clots in areas other than the leg may be impossible to detect by these methods. Diagnosis may require special techniques such as blood-clotting tests or x-rays of the veins. How are venous blood clots treated? Treatment depends on the cause of the blood clot. In most cases, a blood-thinning or anticoagulant medicine will be given. You will need to stay in bed and keep your legs raised for 3 to 5 days. Moist heat and medicines can ease the swelling and pain. For those who have had a clot in the lungs or those who cannot take anticoagulants, a catheterization procedure may be needed to stop further clots. A tiny filter is placed on the end of a long, thin tube called a catheter. The catheter guides the filter to the vessel that carries blood from the legs to the lungs. Then, the catheter is removed, and the filter is left in the vessel to prevent clots from reaching the lungs.
How to Avoid Deep Vein Thrombosis (DVT)
With summer comes summer vacations, and that means many people will be sitting for long periods on airplanes or in cars. These travelers have an increased risk of developing deep vein thrombosis, or DVT. People with DVT have a blood clot in a vein deep within their leg. The clot is usually caused by slowed blood flow to the legs and feet. Because sitting for long periods can slow the blood flow to the legs and feet, that is why travel can increase the risk of DVT. It is also why DVT is sometimes called economy-class syndrome. The easiest way to prevent DVT is to keep moving. If you are taking a long road trip, stop the car every 2 to 3 hours and get out and walk around. A few minutes of walking causes your calf muscles to contract and gets the blood flowing normally again through your legs. If you are traveling by plane or train and the trip is longer than 3 hours, get up every half hour or so and walk up and down the aisles. If you are sitting in a window seat and do not want to disturb the people beside you, try flexing your ankles and your leg and hip muscles while you are seated. In addition to sitting for long periods, dehydration can thicken your blood and increase the risk of clots. Make sure you drink lots of water while you are traveling. Caffeine and alcohol cause dehydration, so you are better off drinking water or juices on long flights and avoiding soft drinks, coffee and tea, and drinks containing alcohol. If you have a layover or when you arrive at your destination, walk quickly through the airport or train station to restore the circulation in your legs. For most people, the risk of DVT is low. However, by following these simple tips, you can lower your risk even more. Pulmonary Embolism Pulmonary embolism is caused by a blood clot (pulmonary embolus) that breaks loose from where it formed in a vein and travels to your lungs. What are the symptoms of pulmonary embolism? Pulmonary embolism may have no symptoms, so it can cause sudden, unexpected death. When symptoms do happen, they may include
- Chest pain, especially when you breathe in.
- Shortness of breath.
- Coughing up blood.
How is pulmonary embolism diagnosed?
Doctors will begin by checking the oxygen level of the blood in your arteriesa low level may mean there is an embolus in your lungs. The diagnosis is usually confirmed by radioisotope scanning. Follow-up may include pulmonary angiography, a catheter procedure in which dye is injected into your bloodstream to show blood flow through your lungs. How is pulmonary embolism treated? Most cases of pulmonary embolism are treated with blood-thinning agents, anticoagulant medicines (which keep your blood from clotting), and clot-dissolving medicines (thrombolytic therapy). Surgery may be needed in rare cases to remove the clot, but most patients respond well to the medicines. Phlebitis There are two forms of phlebitis. The most common form is swelling of a vein near the skin!!!s surface, usually in the leg. This is called superficial phlebitis. Swelling of the veins inside the leg is less common but more serious. This is called deep phlebitis. For superficial phlebitis, the area looks reddish and feels painful. The pain of this condition can usually be treated with moist heat, aspirin, or anti-inflammatory medicines. The more dangerous form of phlebitis, deep phlebitis, usually causes greater pain. People with deep phlebitis tend to have a fever. Nuclear scans, venous Doppler flow studies, or the use of a blood pressure cuff around the leg to measure blood flow (plethysmography) will usually confirm if the deep veins are involved. This type of phlebitis is more likely to lead to blood clots in the veins and a possible blood clot in the lungs (pulmonary embolus). If you are diagnosed with deep phlebitis, doctors will usually give you a week-long treatment with a blood-thinning, or anticoagulant, medicine. During this time, doctors will also check for signs of blood clots in your lungs. Your doctor will probably give you an anticoagulant in pill-form to be taken longer-term. See Pulmonary Embolism above. Varicose Veins Varicose veins are swollen, purple veins in the legs that are visible under your skin. They are caused by damage to blood vessels close to the surface of your skin, slowed blood flow, or the damage or absence of normal valves in your veins. Normally, blood flow in the veins is aided by valves, which keep the blood moving upward, against the force of gravity. If these valves are weak or blood flows slowly in the veins, the blood may pool and cause the veins to bulge. Varicose veins are more common in women than in men. The condition also runs in families. Pregnant women may get varicose veins because of hormonal changes and the extra pressure that the baby puts on the lower-stomach area. Varicose veins may also be caused by being severely overweight or by standing for long periods. What are the symptoms of varicose veins? The most obvious symptom is the blue or purple snakelike veins. They happen near the skin!!!s surface and may stand out from your legs. Clusters of flooded capillaries called spider veins sometimes surround varicose veins. Varicose veins may cause an aching or tingling feeling in your legs. You may also find that your ankles swell at the end of the day. In most cases, those who seek treatment for varicose veins do so because they find them unattractive. How are varicose veins treated? In the early stages, a supportive, elastic stocking may relieve the aching and swelling, but it does not cure the condition. Repair may involve injecting a salt solution that causes the veins to shrink. Another option for repairing varicose veins is injecting a fluid (known as a sclerosing agent) that swells the vein wall. Your leg is then bandaged tightly to keep the walls of the veins close together. The scarring that happens in the vein causes the walls of the vein to stick together. Laser treatments are available to treat certain types of varicose veins and spider veins. The heat from the laser is used to destroy the veins, causing them to collapse and seal shut. Surgical repair, called stripping, involves tying the varicose veins at certain points and removing the affected portion of vein. Your body responds by creating new pathways for blood to flow.