Peripheral Vascular Disorders

Peripheral vascular disorders (PVDs) are conditions that can change blood flow through blood vessels in your body. PVDs do not affect the blood vessels in your heart and brain. Disorders may be in your veins or arteries (R-ter-eez), or both. PVD may also be called peripheral arterial disease, or "PAD". PVD is a life-long condition that may get worse over time without treatment. If you have PVD, you are at a higher risk of having heart problems. Most people with PVD stay the same or get better without having surgery.

What are arteries and veins? Veins carry blood (without oxygen) from your body to your heart. Arteries carry blood (with oxygen) from your heart out to your body. Arteries are strong, flexible blood vessels that are able to expand (get bigger) and contract (get smaller). They expand as your heart beats, and contract between heartbeats. Veins are less flexible than arteries. They have valves that open and close to let blood through. Most PVDs are caused by clogged or weakened arteries or veins, or damaged valves in veins.

What are the types of PVDs?

You may have one or a combination of disorders of the arteries. These include:

• Acute arterial blockage: With this condition, you suddenly have severe pain, coldness, numbness, and pallor (paleness) in your arm or leg. Caregivers may not be able to feel a pulse (heartbeat) in your arm or leg.
• Arteriosclerosis obliterans : This is a condition where artery thickening and loss of flexibility makes the inner part of the artery increase in size. This blocks off blood flow and oxygen through the artery.
• Buerger's Disease: This disease may also be called thromboangiitis obliterans. With this disease, small and medium-sized arteries get inflamed (swollen, red and painful). There is decreased blood flow in your toes, fingers, and feet. They may change colors from pale to red as you raise and lower your legs and arms.
• Raynauds Phenomena and Raynauds disease: These are conditions where there are spasms in very small arteries. Your fingers, toes and sometimes your nose and tongue will turn pale, blue or red. You may also lose feeling in them, and they may be painful. This usually happens when you are exposed to cold, or have strong feelings (like excitement or worry). This may also happen while holding on to a vibrating object, like the steering wheel in your car. These problems may only last for a few minutes, or they may last for hours.

• Chronic venous insufficiency: With this condition, there is not enough blood or oxygen getting to your arm or leg. You may have swelling, a feeling of fullness, aching, or tiredness in your leg. Over time, your skin may become pale, blue or red, and ulcers may grow.
• Thrombophlebitis: This condition may also be called venous thrombosis. If blood flow slows down, or you have problems with your blood, blood cells stick together and clot. This may happen after an operation or injury, and during pregnancy. The clot forms in the blood vessel and blocks it. When this happens, you may be able to feel a hard line like a cord on your leg or arm.
• Varicose veins: This is a condition where the veins in your legs get twisted and swollen. The valves in the veins don't work as well, allowing blood to flow through them the wrong way.

What causes PVDs?

There are two main causes of PVDs. If you have one of these causes, you are likely to also have the other one:

• Atherosclerosis: This is a condition affecting large and medium sized arteries. Material sticks to the inside of your arteries, making the inner wall of the arteries rough, hard, and not flexible. This decreases the rate of blood flow through the artery, so less oxygen gets to areas of your body. Blood clots may also form in the artery.
• Hypertension: This condition is also called high blood pressure. With hypertension, the pressure inside your arteries is too high. This can hurt important organs, like the heart and brain.

Am I high risk for getting PVDs?

There are things that increase your chances of getting PVDs that you may not be able to change. These are:

• Being on bedrest after an illness or injury.
• Having diabetes.
• Increasing age. As you get older, your blood vessels become less flexible.
• Long periods without activity, like sitting or standing for several hours without moving around.
• Pregnancy.
• Someone else in your family having heart or blood vessel disease.

Lifestyle factors are things that you can change in the way that you live. Certain lifestyle factors increase your chances of getting PVDs. These include:

• Hyperlipidemia: This is a high amount of fats, or cholesterol in your blood. This may be caused by a diet high in fat and cholesterol.
• Not exercising regularly or at all.
• Obesity: This means that you are 20% or more over the best weight for your body size. Your doctor will tell you if you are obese.
• Smoking.

You may have one or more of the following medical conditions. These conditions may lead to PVDs over time:

• A history of thrombus or embolus (blood clots).
• End stage renal (kidney) disease (ESRD).
• Heart failure or coronary artery disease (CAD).
• Inflammation (swelling) in your legs.
• Your blood clots faster or more easily than normal.

Signs and symptoms of peripheral vascular disorders:

Blood flow is needed to carry oxygen to all areas of your body. Tissues need oxygen to live. When there is decreased blood flow, oxygen is decreased. When tissues do not get enough oxygen, over time they will die. This is called necrosis. Although some people have no symptoms of PVD, you may have one or more of the following signs and symptoms:

• Intermittent claudication: Most people who have PVDs have this symptom. It is painful cramping of your hip or leg, especially while walking. This pain usually goes away with rest.
• Burning pain in your hands, fingers, feet, or toes. You may have pain when you are resting or exercising. It may get better with rest or a warm environment.
• Shiny, tight, cold skin, and uneven hair growth on your skin.
• Skin coloring that is not normal for you. Your skin may be white, red, blue, purple or black.
• Sores on your skin that do not heal, or gangrene. Gangrene happens when body tissue dies. Your skin turns cold and brown or black.
• Decreased or no feeling, or tingling in areas of your body, like your hand or foot.
• Decreased or no strength in areas of your body.

What tests may be done for PVDs?

Caregivers use the results of tests to find out what type of PVD you may have, and what the best treatment is for you. You may have one or more of the following tests:

• Ankle Brachial Index (ABI): This test checks how well blood is flowing through arteries in your legs. This test is usually done in the doctor's office. While you lie on your back, your caregiver will take blood pressure readings on your arms and legs. A stethoscope or a small machine called a doppler is used to hear your blood pressure. A lower blood pressure in your legs than your arms may mean that you have a PVD in your leg or legs. If your blood pressure is different in each of your arms, this may also be a sign of a PVD.
• Blood tests: You may need blood taken for tests. The blood can be taken from a vein in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
• Cold stimulation test: In this test, body parts are exposed to cold to see how they react.
• Doppler ultrasound: This is a special type of x-ray used to see deep and underlying parts of your body. Changes in the speed of your blood flowing through your veins are recorded.
• Magnetic resonance angiography: For this test, you will lie very still while special x-rays are taken. These x-rays give caregivers a good picture of blood vessels and tissues.
• Peripheral vascular arteriography: This test may also be called contrast angiography. Dye is put into an artery, and an x-ray is taken.
• Treadmill test: This test helps caregivers learn how far you can walk, called your maximal walking distance. It also helps them learn your pain-free walking distance. This tells caregivers about the condition of arteries in your legs, and how well your treatment is working.
• Urine tests: You may need urine taken for tests. You may have to urinate in a bedpan or into a container in the bathroom. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have your urine tested more than once.
• Venography: This test is an x-ray of your veins. Dye is put into the veins before the x- ray is taken, so that they can be seen clearly.

How are PVDs treated?

Your doctor will talk to you about the best ways to treat your specific condition. The following are general guidelines to follow if you have PVD.

Exercise:

• Walk one-half to one hour each day. Exercise helps more oxygen get to your legs. If you have pain while walking, stop walking. Change to another exercise, such as lifting hand weights. Wait until the pain disappears, then begin walking again. Stay on a walking plan. Studies show that over time, you will be able to walk further or longer without having pain. For a walking plan to help, you must keep following the plan. If you quit the walking plan, your pain is likely to return.
• Be sure to have well-fitting shoes to walk in. Replace your shoes with new ones when you see that they are wearing out. If you have gangrene, ulcers, or pain in your legs while resting, ask caregivers if you should continue walking.

Take care of your feet:

It is very important that you take care of your feet when you have PVDs, especially if you also have diabetes.

• Look closely at your feet every day. Check for cracks, calluses (hard areas of skin), corns, or ulcers (sores). Tell caregivers if you have any of these problems.
• Wash your feet daily with mild soap and dry them well. Put lotion on your feet if there are no open areas and they are dry. Put powder on them if your feet sweat.
• Cut your toenails straight across, and do not cut them very short.
• Change your socks daily and do not wear tight stockings, socks or shoes.
• Do not walk barefoot, because you may step on a hard or sharp object. If you have ulcers on your feet, you may need to wear special shoes.

• Anti-platelets: These medicines make it easier for blood to flow through your vessels. They may be used to treat intermittent claudication.
• Aspirin: Aspirin helps thin the blood to keep blood clots from forming. If caregivers tell you to take aspirin, do not take acetaminophen or ibuprofen instead. Do not take more or less aspirin than caregivers say to take. Aspirin may be given to treat intermittent claudication. It may also be given after you have surgery for PVDs.
• Hypocholesterolemic: This medicine helps lower cholesterol levels in your blood. This can reduce your risk of heart disease and other medical conditions.
• Vasodilators and Calcium channel blockers: These medicines help blood vessels dilate (open wider). It may help you to walk longer or further without pain.

If you are at risk for PVDs, there are several things you can do that may help prevent them. Ask caregivers for more information on living a "heart-healthy" lifestyle. This means:

Do not smoke. Stopping smoking may decrease signs and symptoms of PVDs or stop them from getting worse.

Eat nutritious, low fat foods. These include fish, fruit, and vegetables. Increase the amount of fiber that you eat. Fiber can be found in many cereals, whole grain breads and beans. Include a variety of foods in your diet.

Limit the amount of alcohol that you drink to no more than two drinks daily.

Exercise regularly. This means at least 30 minutes of exercise, three days every week.

If you need to lose weight, write down the amounts, and what you eat and drink every day. This will help you see eating patterns, and plan where to make changes to help you lose weight.

Control high blood pressure. Learn to relax by deep breathing, meditating or doing other activities when you are under stress.

If you have diabetes, try to keep your blood sugar at a steady level. Check your blood sugar often. Ask caregivers if you should make changes to your diet, exercise, or medications.

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