Peripheral vascular disease

There are certain factors that cause damage to all blood vessels, including those vessels supplying the legs, the heart, the brain and the kidneys. Smoking is the biggest risk factor for this condition but certain medical problems can also affect the blood vessels over time including diabetes, high cholesterol and high blood pressure. Obesity, heart disease and having a close family member with heart disease can also add to your risk.

The risk of PVD increases with increasing age, and it’s more common in men and post-menopausal women.

Uncontrolled and untreated PVD can increase your chance of developing coronary artery disease, which can cause heart attacks, and critical limb ischaemia, which requires urgent medical attention to avoid needing an amputation.

The classical symptom of PVD is pain in the calves or lower legs that comes on with walking or exercise. This can be mild or severe depending on the degree of CVD involved, and is often described as a burning or cramping type of pain. Walking uphill can bring this pain on more quickly than walking on the flat, and resting for a few minutes causes the pain to settle away. This is known as intermittent claudication. In severe cases this pain may start to happen at rest without any activity being involved.

There may also be cooling of the feet, poor hair growth below the knees or weak pulses in the feet that are difficult to feel.

Your doctor will ask about your symptoms and go through any risk factors with you. They will look at the legs and check if all the pulses can be felt, and have a listen to your heart and take your blood pressure.

You may be sent for blood tests to check your cholesterol and sugar levels for diabetes and be referred for further investigations to look more closely at the pressure and blood flow in your circulation. Doppler ultrasounds assess the flow of blood in the veins, and they can measure the blood pressure of the arteries in each leg using an ankle brachial pressure index (ABPI).

You may also be sent for an angiogram, where contrast dye is injected into an artery and x-ray images are taken to identify any blockages.

To understand how your symptoms are affected by activity you may be asked to do a treadmill test, where you walk on a treadmill while your doctor assesses your circulation.

The first thing is to address the risk factors that you can do something about, such as stopping smoking – which is crucial - and losing any excess weight. You can also change your diet and exercise to help improve any diabetes, high blood pressure or high cholesterol that may be present. Your doctor may also prescribe medications for this.

Sometimes medication to thin your blood may also be offered such as clopidogrel or aspirin to prevent against a blood clot forming, and naftidrofuryl oxalate is another medication that can sometimes be used to improve the blood flow if you have leg pain on walking.

Surgery may sometimes be required to restore the blood flow and this is dependent on the severity of your symptoms and the findings of the investigations. During an angioplasty a small balloon is inflated inside the vessel to keep it open and an artery bypass graft uses an artery from elsewhere in the body to create a bridge to bypass the blockage. For most people with PVD (around 75%) the long-term outlook is good with symptoms remaining stable or improving with lifestyle changes and treatment. However, if you have PVD you do have an increased risk of developing heart disease.