Peripheral Vascular Disease
What is Peripheral Vascular Disease?
Peripheral Vascular Disease (PVD) is commonly used to refer to term Peripheral Arterial Disease (PAD), is a disorder which occurs in the arteries. It is a chronic disease wherein fatty deposits, calcium or plaque builds up in the walls of the arteries (Atherosclerosis). If left untreated, it can lead to arterial insufficiency, which means limiting the blood circulation through the arteries that will further result in complete blockage in that area or even lead to the development of clots.
Some other names used to refer to PVD are:
arterial insufficiency of the legs
How do they develop?
Healthy peripheral arteries are stable and unobstructed, allowing blood to freely provide the legs with oxygen, glucose and other nutrients. However, as we age, the peripheral arteries build up plaque - a sticky substance made up mostly of fat and cholesterol. This sticky content narrows the passageway within the arteries and causes them to become stiff, which further restricts the free flow of blood to the organs and limbs. As plaque growth progresses, clots may develop and completely block the artery. If allowed to progress, this can lead to organ damage and loss of fingers, toes, or limbs.
Notably, in PVD cases, the narrowing of blood vessels can be either caused due to Arteriosclerosis (i.e. hardening of the arteries) or blood vessel spasms. A moderate blockage in significant leg muscles, like the calf or thigh, may cause pain when walking that can temporarily decrease with rest but present again due to any kind of movement or activity.
What are the risk factors for PVD?
You’re at higher risk for PVD if you:
don’t get enough exercise
are over age 50
have abnormal/ high cholesterol
have high blood pressure
have heart disease
have a family history of Vascular problems
What are the causes of Peripheral Vascular Diseases?
Many patients experience no symptoms.
PAIN IN MUSCLES WHILE WALKING
Pain in your muscles of the calf, thigh, hip, or buttock while walking (claudication) may signal you have PAD. Typically, the pain occurs after walking a certain distance and then goes away with rest.
PAIN IN LEG WHILE SLEEPING
If you have pain in the leg while sleeping, then it’s worrying as you may have an advanced case of PAD.
BLACKENING OF TOES-GANGRENE
Blackening of toes is called gangrene and means there is critical blockage of vessels. This is a part of the term called Diabetic foot & It requires immediate treatment.
OPEN WOUND OR ULCER ON TOES
An open wound or ulcer on your toes, often at a pressure point on foot, can signal a severe case of PAD. This is also a part of a term called Diabetic foot. An ulcer can progress to gangrene. These symptoms require immediate medical attention.
Numbness or Pain in Toes or Feet
Muscle Fatigue or Cramps
Open Wounds on Feet
How can it be diagnosed?
See Vascular and Interventional Radiologist
You will be asked questions about symptoms and medical history. The vascular and Interventional Radiologist will then also perform a physical exam.
Tests May Be Recommended
Ultrasound Doppler: A simple, non-invasive ultrasound doppler can diagnose peripheral arterial disease and determine its severity.
Ankle-Brachial Index: An another diagnostic test for PAD is the Ankle-Brachial Index (ABI). The test involves taking a blood pressure reading at the ankle and comparing it to that in the arm.
Angiogram (CT/MR/DSA): Typically, an angiogram is done to determine where the in the arteries plaque has built up to assess treatment options. This can be done using a CT or MRI, or possibly by doing a catheter-directed angiogram, which involves placing a thin tube into the artery and injecting dye into the arteries to see where the blockages are located.
How do I know if I have PVD?
If you are having pain while walking, pain at night while sleeping, blackening of toes or wounds that don't heal, then it is likely you have PVD.
Are you facing similar problems?
Consult our EndoVascular Expert doctors to know whether that limb pain needs a possible treatment or not.
What are the complications of PVD?
Complications of Peripheral Vascular Disease include;
non-healing sores or infections
amputation of legs
Newly developed sores or ulcers may not heal on its own, causing further signs of fever, chills, weakness, or other internal/ external infections which are usually ignored. If they stay undiagnosed and untreated, it can lead to severe injuries and even turn fatal. The areas receiving limited blood flow are also more prone to develop infections and, in extremities, amputation may also be necessary.
Restricted blood flow of PVD needs to be considered as a warning sign of other forms of vascular diseases like Diabetic Foot Ulcer or Foot Gangrene.
Diabetic foot ulcer
It is usual for diabetic patients to experience painful ulcers or open sore or wounds on the bottom of the foot (typically in the toes). Diabetic foot ulcer symptoms include swelling, redness, cracks/ sores, pus, odour and also a pain in the ankle.
Due to the loss of blood supply, often the patients can be hospitalized due to infection or other ulcer-related complications. In the rarest form, the decreased circulation can lead to open wounds, ulcers, gangrene, or different infections to the extremities.
Diabetic patients with foot ulceration have an excess mortality rate when compared with diabetic counterparts without foot complications and the general population. It can also progress into gangrene hence requiring immediate medical attention.
Foot Gangrene is caused by a critically lacking blood supply (e.g., peripheral vascular disease) or infection. It is commonly associated with diabetes and long-term tobacco smoking. Symptoms of Foot Gangrene include dry and itchy skin, bleeding beneath the skin, numbness or swelling, throbbing pain and pus-filled lesion.
If there is the sudden development of a cold, painful, pale limb with weak or no pulses, it is considered as a medical emergency. The patient will require treatment as soon as possible in order to avoid severe complications and amputation.
Places We Operate From
Get the best-in-class treatment & services now near you. You can find our speciality centres for Peripheral Vascular/ Arterial Disease Treatment in Mumbai, Navi Mumbai, Nagpur & Aurangabad.
We are the largest endovascular group in the country. All our experts are board-certified, extensively trained Interventional Radiologists, with all of us having experience of more than 5 years.
What is the treatment?
Treatment depends on the symptoms and findings on USG Doppler or angiography. If there is a critical blockage, then angioplasty & stenting may be required. In angioplasty, a balloon is inflated to open the vessel & if the needed stent is then deployed.
Before & After the procedure
The patient is asked to be fasting 6 hours before the procedure. After the procedure is complete, the patient is observed overnight and discharged the next day itself. The patient can walk from the next day itself.
Will I have to pay separately for Arterial Doppler?
No, an Arterial Doppler is included in our consultation. Our advantage is that we do our own dopplers, helping us in planning your treatment and also evaluating you on follow-up.
Benefits of endovascular angioplasty and stent procedures
Endovascular angioplasty and stenting is a minimally invasive procedure, involving no cuts/sutures. The patient is, therefore, able to walk from the next day and hence gives the patient faster recovery.
While it varies from hospital to hospital & depending on the number of balloons/stents that will be required, it usually is around 1.25 lakhs. Our experts will be able to give the expected budget after evaluating you.
Care taken after the procedure
From the very next day, the patient is able to walk after which s/he is advised to walk for 30 minutes to 1 hour every day. Patients are recommended to regularly take their medications, including blood thinners, diabetes, and blood pressure medications. Regular sugar & BP monitoring is a must. Also, follow-up, as advised by our experts, should be followed diligently.
Are these procedures safe?
Absolutely. The procedure of angioplasty is performed through a pin-hole & involves no cuts/sutures. The patient is, in fact, mobile from the next day itself. The procedure is done under local anaesthesia, and the patient is conscious during the entire procedure. At The Vascular Center, we believe in using the powers of music to help boost the spirits of our patients and healthcare staff. We in fact play music of the patient's choice during the procedure, just to calm them down and decrease their stress.