Vascular disease is any condition that affects the circulatory system and ranges from diseases of your arteries, veins, and lymph vessels to blood disorders that affect circulation. With every beat of our hearts, oxygen rich blood is pumped through blood vessels called the circulatory system to every part of the body. Arteries carry blood away from the heart to the rest of our body while veins return it. When any part of the circulatory system is weakened by disease, there is a loss or shortage of blood flow to various parts of the body which can lead to anything from pain in the legs to aneurysms or loss of limbs. Seventy percent of all amputations are not due to diabetes or trauma but because of some form of vascular disease. We’re going to explore the numerous conditions that fall under the category of vascular diseases, the effects, and causes and how to avoid or treat them.

Peripheral Artery Disease (PVD) is a common condition that affects approximately ten million adults in the U.S. About 5% of people over the age of 50 are believed to suffer from peripheral artery disease and it is slightly more common in men than in women. While it most often occurs in people over the age of 50, this disease is not exclusive to older people and can develop in younger people with more than one risk factor. The peripheral arteries are the blood vessels outside your heart. When they have a build-up of fat and cholesterol deposits on the inside walls it is known as atherosclerosis. Over time, the build-up narrows the artery and eventually the narrowed artery causes less blood to flow and a condition called “ischemia” can occur. Ischemia is inadequate blood flow to the body’s tissue.

Atherosclerosis is the leading cause of Peripheral Artery Disease. A number of other conditions can cause PVD such as vasculitis which is inflammation of the blood vessels that may cause damage to blood vessels throughout the body. This can either be a primary condition or associated with connective tissue diseases such as lupus. Injuries to blood vessels from traumatic accidents such as auto accidents or sports injuries can lead to PVD. Blood-clotting disorders and damage to blood vessels during surgery can also lead to tissue ischemia and eventually PVD.

The known risk factors for peripheral artery disease are those that predisposed to the development of atherosclerosis, high cholesterol, low blood levels of the good HDL cholesterol, cigarette smoking, Diabetes mellitus (both type 1 and type 2 diabetes), high blood pressure (hypertension) or a family history of hypertension, chronic renal failure, being overweight or obesity and physical inactivity. A person with a combination of two risk factors such as diabetes and smoking or being physically inactive and smoking has an increased likelihood of developing more severe peripheral artery disease than a person with only one risk factor.

Just as a blockage in the coronary arteries inside the heart can cause a heart attack, a blockage in other arteries can have devastating effects. A blockage in the carotid arteries which supply blood to the brain can lead to a stroke. A blockage in the renal arteries that supply blood to the kidneys can cause renal artery disease (stenosis) which leads to uncontrolled high blood pressure, heart failure, and abnormal kidney function. A blockage in the legs can lead to leg pain, cramps with activity, changes in skin color, sores, ulcers, and feeling tired in the legs while total loss of circulation in the legs can lead to gangrene and loss of a limb.

Approximately half of people with peripheral artery disease do not experience any symptoms but those that do experience symptoms experience leg or arm pain that occurs with exercise and ceases at rest, pain in the limbs at rest which is a more serious form of the condition, numbness of extremities, a feeling of coldness in legs or feet, weakness and atrophy of the calf muscle and changes in color of the feet; feet are pale when elevated and turn red in standing or sitting position. Painful ulcers and/or gangrene in tissue (typically the toes) where there is critical ischemia can also occur.

Treatment of peripheral artery disease includes lifestyle changes, supervised exercises, medications, angioplasty, and surgery. Lifestyle changes such as quitting smoking which eliminates a major risk factor and maintaining a healthy diet which can help lower blood cholesterol and other lipid levels as well as help control blood pressure are at the forefront of treatment. Proper supervised exercise on a regular basis can condition the muscles to use oxygen effectively and can speed the development of collateral circulation. Patients should be enrolled in rehabilitation programs supervised by healthcare professionals such as nurses or physical therapists with exercise at least three times a week with each session lasting longer than 30 to 45 minutes.

While these changes may be enough treatment for some people with PVD, others may require medication. Medications such as antiplatelet or anticlotting agents, cholesterol-lowering drugs such as statins, medications that increase blood supply to the extremities such as cilostazol (Pletal) and pentoxifylline (Trental), or medications that control high blood pressure may be needed as well. In more advanced cases of PVD where damage to blood vessels or clots have already occurred- angioplasty may be advised as treatment. Angioplasty is a nonsurgical procedure that can widen a narrowed or blocked artery when a thin tube (catheter) is inserted into an artery in the groin or arm and advanced to the area of narrowing. A tiny balloon on the tip of the catheter is then inflated to enlarge the narrowing in the artery. Angioplasty may be performed by an interventional radiologist, cardiologist, or vascular surgeon using local anesthesia. The last option of treatment in the most advanced cases is surgery. Surgical treatment for peripheral artery disease involves either bypass surgery performed by a vascular surgeon. Indications for surgical treatment of peripheral artery disease include long lesions on a vessel that, for anatomical reasons, may be difficult to treat by angioplasty.

Eliminating your risk factors as well as maintaining a healthy diet and regular exercise are the best ways to avoid developing PVD. Eating foods rich in vitamin E and vitamin K, which are both beneficial in controlling bleeding and blood clot formation will also help you avoid developing PVD. Fish oil also helps with blood thinning which reduces your risk of clots. Consult your doctor if you have more than one risk factor or believe you have experienced symptoms of PVD. As with any disease, early detection and treatment can help you avoid the more extreme effects such as loss of limbs or stroke.

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