Dr Jason Toniolo

Peripheral vascular disease

Peripheral vascular disease (PVD) is the narrowing or blockage of blood vessels, primarily in the legs, caused by atherosclerosis.

It reduces blood flow to the limbs, causing discomfort, pain, and potential complications. PVD is often underdiagnosed, but it is a significant indicator of systemic cardiovascular disease, warranting timely diagnosis and management.

Intermittent Claudication

What Causes the Pain and Where Are the Symptoms?

Intermittent claudication is the most common symptom of PVD. It manifests as pain, cramping, or tiredness in the leg muscles during walking or exercise, which subsides with rest. Claudication occurs due to blood flow to muscles being limited by narrowing or artery blockages. Symptoms often affect the calves but can also involve the thighs or buttocks, depending on the location of the arterial blockage.Critical Limb Threatening Ischaemia

What Are the Signs and How Urgent Is It?

 

Critical limb-threatening ischaemia (CLTI) is a severe form of PVD where blood flow is so restricted that it endangers the survival of the affected limb. Signs include persistent pain at rest, often worse overnight when the leg is elevated, with symptoms improved by hanging the leg over the edge of the bed or sitting up to help gravity get blood to the toes. It also presents with non-healing ulcers or gangrene. CLTI is a medical emergency requiring prompt intervention to prevent loss of tissue.

What are the risk factors

Key risk factors for PVD include smoking, diabetes, hypertension, hyperlipidemia, and a family history of cardiovascular disease. Lifestyle modifications, such as smoking cessation, healthy diet, and regular exercise, are essential for mitigating disease progression. Managing comorbidities like diabetes and high blood pressure also plays a critical role in preventing complications.

treatment options

Treatment options for PVD include endovascular and open surgical procedures.

 

Endovascular treatments (angioplasty, stenting, atherectomy)

  1. Minimally invasive and offer shorter recovery times.
  2. They are effective for many patients but may require repeat interventions.
  3. Best suited to narrowing in arteries identified in particular parts of the body
  4. The suitability depends on how long the narrowing is and where it is

Open surgery (endarterectomy or bypass graft)

  • More invasive with longer recovery but more durable results
  • Best for long, severe blockages
  • The choice of treatment depends on the severity of the disease, the patient’s overall health, and the location of the blockage.