Peripheral Vascular Disease (PVD), also known as Peripheral Artery Disease (PAD) is a condition that commonly impacts the blood vessels outside the heart and brain. It affects blood flow to the limbs, especially the legs, which is restricted due to narrowed or blocked arteries.
PVD diagnostic tests play a vital role in identifying the severity and location of blockages in the arteries. The evaluation process includes a range of tests, from non-invasive options like the Ankle-Brachial Index (ABI) and Doppler Ultrasound to advanced imaging tests such as Computed Tomography Angiography (CTA).
Early detection of PVD matters because it not only affects mobility but also increases the risk of serious complications like heart attacks and strokes if left untreated. Accurate diagnosis allows for timely intervention to prevent disease progression and improve quality of life.
At CACVI, we have experienced vascular specialists who offer expert evaluation and a full range of diagnostic services to help patients who believe they are suffering from peripheral vascular disease and other vascular conditions. With over 15,000 vascular and cardiac procedures carried out, you can be sure that we will come up with personalized treatment plans for your health benefit.
What Is Peripheral Vascular Disease?
Quick answer
Peripheral vascular disease means the arteries carrying blood to your legs have narrowed, so less blood gets through. Testing for it starts simple. An ankle-brachial index compares the blood pressure at your ankle to the pressure in your arm. A Doppler ultrasound shows where the flow slows down. If those point to a blockage, a CT angiogram maps exactly where it sits. None of it hurts, and most people finish in one visit.
Peripheral vascular disease (PVD) is a progressive circulation disorder primarily caused by atherosclerosis. This occurs when plaque builds up on the walls of the blood vessels, restricting blood flow to the limbs and organs. Generally, this plaque reduces blood flow, oxygen, and nutrients to tissues, often most severely affecting the legs and feet. PVD can impact any blood vessel outside the heart, including arteries, veins, and lymphatic vessels, and is commonly found in individuals with coronary artery disease (CAD).
While atherosclerosis is one of the main contributors to PAD, other factors such as high blood pressure, smoking, diabetes, high cholesterol, and family history are big PAD risk factors. All these are major contributors to the disease progression. Age is also a risk factor, as older adults are at a higher risk. Furthermore, other health issues such as coronary artery disease, abdominal aortic aneurysms, and blood clots can contribute to PVD.
Furthermore, one symptom of peripheral artery disease is intermittent claudication. This refers to leg pain or cramping during activity. Other symptoms include poor wound healing, skin changes, muscle wasting, severe pain, numbness or weakness in extremities.
What Is a Peripheral Vascular Assessment?
Typically, patients may reports symptoms such as leg pain, numbness or difficulty in walking, especially during physical activity. Such reports lead to getting a thorough vascular assessment which begins with a detailed overview of the patient’s medical history. During a physical exam, doctors look for physical signs such as weak pulses in the legs and feet, skin changes, and ulcers.
A peripheral vascular assessment includes evaluating blood flow and peripheral pulses using tools like the Ankle-Brachial Index (ABI) and Doppler Ultrasound. Additional tests like Magnetic Resonance Angiography (MRA), treadmill exercise tests, and contrast dye imaging help identify blockages in major arteries such as the femoral arteries, popliteal artery, and carotid arteries.
Assessing symptoms like a capillary refill, skin temperature, and changes in the dorsal artery or posterior tibial pulses, along with physical exam findings, enables early detection of artery narrowing or blockages. With accurate diagnosis, timely interventions such as vascular surgery or balloon angioplasty can help restore proper blood flow and prevent complications like poor wound healing and amputation in severe cases.
How is Peripheral Vascular Disease Identified?
In addition to a complete medical history and physical exam, we may perform other tests to diagnose peripheral vascular disease, including:
- Peripheral angiogram: Peripheral Angiogram is a test that uses X-rays and contrast dye to help your doctor find narrowed or blocked areas in one or more of the arteries that supply blood to your legs. If there is a narrowing of the artery, it can be treated in the same setting or a different setting with balloon angioplasty.
- Peripheral venography: This is an invasive diagnostic test used to provide images of the veins in the legs. During peripheral venography, a contrast dye will be injected into a vein, often in the patient’s foot. X-ray pictures are taken of the veins to determine if there are any DVT’s or abnormalities.
- Vascular ultrasound flow studies: A vascular ultrasound is a noninvasive ultrasound method (also called a duplex study) used to examine the circulation in the blood vessels of the body. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Faintness or absence of sound may mean blood flow is blocked.
- Magnetic resonance angiography (MRA) or magnetic resonance venography (MRV): This noninvasive test uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures in the body. Your doctor injects a special dye during the procedure so that blood vessels are more visible.
- Stress test: A stress test, sometimes called a treadmill test or exercise test, a stress test helps us find out how well your heart handles its workload. You will walk on a treadmill so we can monitor blood circulation during exercise.
How to Treat Peripheral Artery Disease
Typically, effective treatments for PAD focus on improving blood flow, relieving symptoms, and preventing disease progression. One way to treat PAD is through lifestyle modifications such as smoking cessation and exercise. Quitting smoking is essential, as smoking accelerates plaque buildup in the artery walls, worsening PAD and raising the risk of blood clots and heart disease. Likewise, regular physical activity, such as a structured treadmill exercise test program, improves circulation and helps manage symptoms. Walking exercises can reduce intermittent claudication and improve leg strength. It also helps to maintain a heart-healthy diet as it manages blood pressure and reduces cholesterol.
Another way to treat peripheral arterial disease is with medication. Typically, antiplatelet agents such as aspirin help prevent blood clots from forming in narrowed arteries. Cholesterol-lowering drugs and blood pressure medications are also helpful as controlling high blood pressure. They reduce strain on the vascular system, particularly on major arteries like the abdominal aorta and femoral arteries.
Peripheral artery disease can also be treated with surgical options as well. An example of such a surgical option is bypass surgery. In cases of severe blockage, a graft may be used to bypass the blocked artery and restore blood flow. Bypass grafting is often performed for major arteries like the femoral arteries. You could also undergo an endarterectomy. This procedure involves removing plaque directly from the artery wall to improve blood flow.
In extreme cases where blood flow cannot be restored, and poor wound healing or tissue death occurs, amputation may be necessary.
What Doctor Treats Peripheral Arterial Disease?
Peripheral Arterial Disease (PAD) is typically managed by a vascular specialist or vascular surgeon. They specialize in diseases affecting the circulatory system, including blocked or narrowed arteries and poor blood flow. These doctors perform vascular assessments, monitor blood flow, and evaluate peripheral pulses to diagnose and treat PAD.
Cardiologists may also be involved in PAD treatment, especially if the patient has coexisting conditions like coronary artery disease or high blood pressure. In some cases, general practitioners play an important role in initial physical exams, ordering noninvasive tests, and managing risk factors like blood pressure and cholesterol levels before referring patients to specialists.
How Long Do You Need to Recover?
The recovery time for PAD treatments depends on the severity of the disease, the specific procedure performed, and the patient’s overall health. For patients who only have to undergo lifestyle changes and medication, recovery is usually gradual and may span over some weeks.
However, for those who have to undergo surgical procedures, recovery may take around 6 to 12 weeks. In extreme cases where amputation is necessary due to complications like severe poor wound healing or gangrene, the recovery time can span over 6 months. This is because physical therapy and rehabilitation may be required.
Peripheral Vascular Disease Evaluation FAQs
How do you assess peripheral circulation?
Peripheral circulation is assessed through various methods to gauge blood flow and detect any arterial insufficiencies. It often starts with a physical examination. Then, you could undergo a capillary refill test, ankle-brachial index (ABI) test, doppler ultrasound test, etc.
What is peripheral vascular assessment?
A peripheral vascular assessment is a full examination of the blood vessels, both arteries and veins, in the extremities to evaluate blood flow and identify potential circulation issues. These issues could include peripheral artery disease (PAD) or venous insufficiency.
What are the findings of a PAD exam?
During a Peripheral Artery Disease (PAD) exam, several findings may indicate compromised blood flow. They include weak or absent peripheral pulses, abnormal ankle-brachial index, skin changes, etc.
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