Peripheral Vascular Disease (PVD)

Dr. Cambria talking
Peripheral vascular disease, or PVD, is the narrowing or blockage of arteries that carry blood throughout the body. The most common cause of PVD is atherosclerosis, or the hardening of the arteries. Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called plaque that narrows the blood vessels. Eventually, if an artery becomes very narrow, clot can form within it and prevent any blood from flowing beyond the blockage.

Treatment of PVD has three aims, some of which overlap. The first important aim is to treat the systemic disease of atherosclerosis. People with PVD are at increased risk of suffering a heart attack. Treatment for this purpose consists of lifestyle modifications and medication, including quitting cigarette smoking, maintaining a healthy diet, and increasing activity levels. Medications designed to inhibit platelets (aspirin) and control cholesterol are frequently recommended.
The next aim in treating PVD is to increase the ability to walk. Smoking cessation alone usually increases pain free walking distance. Exercise programs are also effective. There are medications that can improve the walking distance as well, and these may be recommended by your doctor in certain instances. In the most severe cases, or in otherwise young healthy individuals, your doctor may recommend repair or bypass of blocked arteries to improve the circulation and increase exercise tolerance.

The final aim in the treatment of PVD is to increase the circulation to the extremity by either addressing the blockages directly or by performing bypass procedures around the blockage. These types of treatment are generally reserved for those with more severe degrees of blockage, or for otherwise healthy patients who are very limited by their circulation. Two general options are available to increase the circulation of the leg. The first approach is called endovascular or percutaneous therapy. This is a minimally invasive procedure where catheters and other devices are used to treat the blockages directly without the need for open operation. These types of procedures can frequently be done as an outpatient, or with an overnight stay. When feasible, this approach is well tolerated and can provide durable relief of symptoms.

Not all patients can be treated with endovascular therapy. In those individuals, open surgical approaches to remove or bypass the blockages in the arteries are necessary. These are major surgical procedures, and are usually only performed when the disease is advanced and there are no other alternative to save the limb. These types of procedures are generally very successful however, and long term durability is quite good.

Treatments for PVD are chosen carefully for the individual patient. In those with minimal symptoms, lifestyle modification and medication are typically all that is required. Please be sure to discuss all options with your healthcare provider and understand why a particular course of action has been planned for your situation.