Quality of Life Interventions from the Columbia University Department of Surgery
Peripheral Vascular Disease: Risk-Factors, Screening and Treatment
Peripheral Vascular Disease (PVD)
Cholesterol or scar tissue buildup in the arteries of the legs, causing them to narrow
James A. McKinsey, MD
Interim Chief, Division of Vascular Surgery
As we get older, it is a natural thing to get pain in our legs when walking, right?
Wrong. Pain in the legs or feet while walking should not be considered a normal part of aging. It could be a sign of peripheral
vascular disease, or PVD — the buildup of fatty deposits (plaque) in the arteries beyond the heart. This buildup can block blood
supply throughout the body, but most dangerously to the brain, kidneys, and legs.
PVD is also called lower extremity vascular disease or Peripheral Arterial Disease (PAD). The most common symptoms of the
disorder are claudication (pain in the calf, thigh or buttock while walking), pain in the feet with elevation of the legs, and wounds or sores on the feet or legs
that do not heal. Patients with even a moderate amount of arterial blockage may not have noticeable symptoms. Others may have symptoms, but not realize
that their difficulty with walking is a result of PVD. Without the awareness of PVD, this problem may go undiagnosed, with patients suffering unnecessarily.
The main risk factors for PVD are preventable: smoking, elevated cholesterol, diabetes, lack of exercise, and high blood pressure (hypertension). People with
chronic kidney disease or diabetes who also smoke face an especially high risk of developing PVD. Although the specific genetic markers for PVD have not
yet been identified, it is clear that certain populations (such as Hispanics and African Americans) have a higher predisposition to diabetes and PVD, and that
some families have a genetic predisposition to developing PVD.
As part of their treatment for PVD, most patients need to make lifestyle changes such as quitting smoking, eating a healthier diet, and exercising more. Some
need medications to help lower cholesterol or blood pressure. In serious cases, patients can be treated with a minimally invasive procedure. A minority require
surgery to clean out or bypass the arteries.
Fortunately, screening is available. Screening for PVD is simple, noninvasive, and cost-effective. It is done by measuring the blood pressure at the ankle with a
blood pressure cuff and comparing this measurement with the blood pressure taken at the arm. Many cardiologists and vascular surgeons have this equipment
in their offices today. Overall, most doctors recommend screening for people who smoke or have other risk factors.
Cholesterol or scar tissue
buildup in the arteries of the
legs, causing them to narrow