PVD-Arterial Blockage


Arterial blockage is a type of peripheral artery disease (PAD) that occurs when the peripheral arteries become blocked by the same type of plaque that blocks the coronary arteries. Patients are more likely to develop PAD as they age; in fact, 1 in 3 people age 70 or older has PAD. Patients who smoke or have diabetes develop PAD sooner in life.

What Causes Arterial Blockage?

Atherosclerosis is the disease process wherein plaque forms and accumulates on the inside of an artery. Affected arteries become clogged, and blood flow is slowed or stopped. Decreased blood flow causes ischemia, depriving the body's cells of oxygen. Clogged coronary arteries lead to a heart attack; clogged carotid arteries lead to a stroke; and clogged peripheral arteries in the lower part of the body cause leg pain and cramping. The risk factors for PAD are smoking, diabetes, high blood pressure, high cholesterol, obesity, and having high levels of homocysteine (an amino acid) in the blood.

Symptoms

Pain in the feet, shins, calves, thighs, hips, or buttocks may occur, depending on the location of the arterial blockage. The severity of the pain usually corresponds to the severity of the blockage. Leg cramps that develop while walking and worsen with increased activity are caused by intermittent claudication (IC). Other symptoms of IC include leg tightness, heaviness, cramping, or weakness, especially during activity. Similar to angina, IC usually subsides with rest. Cold temperatures and some medicines may also cause leg pain. Serious cases of arterial blockage can cause blue toes, cold feet, and a weak pulse in the legs. If the tissue is deprived of blood flow and oxygen for an extended period of time, ulcers may form, followed by tissue death (gangrene).

Diagnosis

Arterial blockage can be diagnosed with a complete history and physical examination, documentation of its symptoms, and detection of weak pulses in the feet or behind the knees. Diagnostic tests include blood tests, an ankle-brachial index test, duplex ultrasound, pulse volume recording, different forms of diagnostic angiography, and arteriography.

Treatment

If it is not severe, the symptoms of arterial blockage can be controlled through weight loss, smoking cessation, and a physician-approved daily exercise program. Medicines may be prescribed to address the contributing causes or control the symptoms of PAD, including cholesterol medications, blood pressure medications, or medications that reduce clotting. Additional treatment may include percutaneous transcatheter intervention (balloon or cold angioplasty or a peripheral stent) by an invasive cardiologist or peripheral vascular bypass surgery performed by a vascular surgeon. The bypass surgery uses an artificial vessel or another of the patient’s own veins to divert blood to flow around one or more narrowed vessels. Another procedure called endarterectomy surgically removes the artery-clogging plaque; it is also performed by a vascular surgeon. Surgical amputation is performed as a last resort in the most severe cases.

Resources

Texas Heart Institute www.texasheartinstitute.com/HIC/Topics/Cond/pvd.cfm
Society for Vascular Surgery www.vascularweb.org/patients/NorthPoint/Leg_Artery_Disease.html

Updated December 2009