Peripheral Vascular Disease (PVD)
Peripheral Vascular Disease (PVD) is a broader condition affecting both arteries and veins, leading to poor circulation in the extremities.
Peripheral Artery Disease (PAD)
Peripheral Artery Disease (PAD) is a condition where narrowed arteries reduce blood flow to the limbs, usually due to atherosclerosis.
Swelling (Edema)
Blood pools in the legs, causing fluid to leak into surrounding tissues, leading to swelling.
Varicose Veins
Increased pressure from pooling blood causes veins to enlarge (varicose veins)
Skin Discoloration
Increased pressure from pooling blood damages small blood vessels in the skin, leading to color changes.
Leg Pain
Legs may feel tired, achy or heavy after standing for long periods
Symptoms of severe or end-stage PVD caused by venous disease
Advanced venous disease can lead to painful, hard-to-heal sores (venous ulcers) especially around the ankles.
Another potentially life-threatening symptom is Deep Vein Thrombosis (DVT), in which a blood clot (thrombus) forms in a deep vein, often in the leg, restricting blood flow. This causes pain, swelling, warmth, and redness in the affected leg. If untreated, a part of the clot may break off and travel to the lungs, resulting in a pulmonary embolism (PE), a serious and potentially fatal complication.
Causes of peripheral vascular disease
Venous peripheral vascular disease (or venous disease) typically arises from weakened or damaged valves in the veins. Normally, these valves act like one-way doors, helping push blood upward, against gravity, from the legs back to the heart. When these valves become weak or damaged, they can’t close tightly, so that blood leaks backward and pools in the veins, especially in the legs. Over time, this backward flow increases pressure inside the veins, making them swollen and less efficient at circulating blood.
Several factors can contribute to valve damage:
- Aging
- Prolonged sitting or standing
- Pregnancy
- Obesity
- Genetics
Symptoms of peripheral artery disease (PAD)
Arteries carry oxygen-rich blood from the heart to the rest of the body. When arteries in the legs become narrowed or blocked (as in PAD), oxygen delivery to the muscles and tissues is restricted. This lack of oxygen causes pain and dysfunction, especially with physical activity, because the muscles demand more oxygen when working.
Leg pain during exercise (claudication)
Coldness in legs or feet
Numbness or weakness
Poor wound healing
Discoloured skin
Weak/absent pulse in feet
Causes of Peripheral Artery Disease (PAD)
Peripheral Artery Disease is commonly caused by atherosclerosis, where plaque made of cholesterol, fats, calcium, and other substances builds up in the peripheral arteries. Plaque buildup in arteries makes them hard and narrow, restricting blood flow. This reduces oxygen and nutrients to muscles and tissues, especially in the legs, causing pain and other symptoms.
Contributing factors for plaque formation in peripheral artery disease
The reasons why the plaques form can vary and are influenced by different risk factors and lifestyle habits.
damages the artery walls, making it easier for plaque to form.
levels in the blood, especially LDL (low-density lipoprotein), also referred to as “bad” cholesterol, tend to adhere to the inner lining of the arteries.
weakens and damages arteries, allowing plaque to build up more easily.
accelerates the process of atherosclerosis by damaging blood vessels and making them more prone to plaque formation.
naturally increases the risk of PAD because arteries can stiffen and become more prone to damage as we get older.
of atherosclerosis or heart disease also plays a role, as some people are genetically predisposed to developing plaque in their arteries.
Treatment options
Treatment for Peripheral Vascular Disease (PVD) depends on the type of blood vessel affected—arteries, veins, or lymphatic vessels. Options include lifestyle changes, medications, minimally invasive procedures, and surgical treatments. Each approach aims to improve blood flow, reduce symptoms, and prevent complications.
How to treat venous PVD
Treatment of PVD (such as chronic venous insufficiency) focuses on improving blood flow in the veins and reducing symptoms caused by blood pooling in the legs.
This can be achieved through several measures, such as:
- Regular movement / avoiding long periods of sitting or standing
- elevating the legs
- compression stockings can help reduce swelling and improve blood return to the heart.
Although chronic venous insufficiency is primarily managed by lifestyle changes, medications that strengthen the walls of the veins and improve blood flow can be beneficial. Anti-inflammatory medications may also help with pain and swelling. For conditions like Deep Vein Thrombosis (DVT), blood thinners may be prescribed to prevent or dissolve clots.
Sclerotherapy and endovenous laser therapy are commonly used to treat varicose veins and vein blockages. Sclerotherapy involves injecting a solution that closes off the vein, while laser therapy uses heat to seal it. For severe cases, vein stripping (removing damaged veins) or other surgical procedures may be needed to improve blood flow in the legs.
How to treat PAD
For arterial peripheral vascular disease (such as PAD), treatment focuses on improving blood flow through narrowed or blocked arteries.
- Regular exercise, especially walking, can help improve circulation and reduce symptoms like leg pain.
- Quitting smoking
- Eat a heart-healthy diet
- Control of blood pressure and cholesterol
Doctors may prescribe different medications to improve blood flow and prevent blood clots, lower cholesterol, and manage blood pressure.
Angioplasty and stent placement are common procedures to open blocked arteries. In angioplasty, a tiny balloon is inflated inside the artery to widen it, and a stent (a small metal mesh tube) may be inserted to keep the artery open.
Management of chronic pain in peripheral vascular disease
Pain management in PVD depends on the specific symptoms and areas affected. A range of different strategies can be used, such as:
- Regular, gentle exercise and movement
- Medication for pain relief
- Compression stockings can help relieve discomfort by reducing swelling
- Applying cold packs (venous PVD) or warm packs (PAD)
- Peripheral Nerve Stimulation (PNS) can also be considered a treatment option for managing chronic pain associated with Peripheral Vascular Disease (PVD). It involves the implantation of a small device near a peripheral nerve responsible for transmitting pain signals to the brain. The device, known as a neurostimulator, sends mild electrical impulses to the nerve, effectively blocking these pain signals and providing relief.
- Learn how peripheral nerve stimulation works >>
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