Peripheral vascular disease

Peripheral vascular disease (PVD) is a blood circulation disorder which causes the blood vessels outside the heart and brain to narrow or block. This occur in the arteries due to atherosclerosis (hardening of the arteries). It may also affect the blood vessels that supply blood and oxygen to your limbs, stomach and intestines or the kidneys.

The main risk factors for developing atherosclerosis and subsequent peripheral vascular disease are:

• Hypertension
• Hypercholesterolaemia
• Diabetes
• Smoking

Peripheral vascular disease of the lower limbs is by far the most common form of clinical presentation. People diagnosed with peripheral vascular disease of the lower limbs could have the following complaints (in order of severity):

• Asymptomatic
  In early stages, the disease will not produce any clinical symptoms.
• Intermittent claudication
  Claudication is pain experienced during any form of exercise (such as walking). It is usually felt in the calves or buttocks and happens because the narrowed vessels cannot meet the muscles’ increased demand for oxygen during exercise. The distance you can walk is inversely proportional to the severity of the disease (i.e. the further you can walk, the less severe is the disease).
• Incapacitating claudication
  Claudication is termed incapacitating when it leads to impairment in the patient’s normal day-to-day functioning.
• Critical limb ischaemia
  Critical ischaemia is present when there is either ‘rest pain’ (pain at rest that is usually severe enough to keep the patient awake at night) or tissue loss (either a chronic ulcer/wound or the presence of gangrene).

Treatment options for peripheral vascular disease:

• Asymptomatic & intermittent claudication
  A structured exercise program is a mainstay of treatment. This will lead to a gradual increase in the distance you can walk pain-free. This requires dedication but will lead to an improvement in your peripheral vascular disease by forcing your body to open up ‘new’ blood vessels to the affected areas and thus supply more oxygen to the compromised tissues.
• Incapacitating claudication
  The determination of what is incapacitating will differ from person to person. When to intervene in this situation can be a very difficult decision. The advantages of intervention need to be weighed against the potential complications. You will have to make an informed decision after a thorough discussion with the surgeon.
• Critical limb ischaemia
  Intervention will always be necessary for this group if an amputation is to be avoided. Intervention can take the form of either endovascular therapy, where a catheter is used to widen the artery from the inside and possibly place a stent or open surgery to in order to bypass the blocked artery using either the patient’s own veins or an artificial tube graft.