Peripheral Vascular Disease
Diagnosis and Treatment of Inadequate Blood Flow to the Legs
Leg pain may actually be a sign of disease in the peripheral arteries if certain risk factors are present.
Peripheral vascular disease (PVD), also known as peripheral arterial disease (PAD), is a condition typically secondary to atherosclerosis, which some people may not be aware of. Instead of narrow arteries limiting blood flow to the heart or brain, PVD involves this phenomenon with the legs. It affects about 10% of Americans, but this prevalence may possibly increase.
Symptoms and Signs
A common symptom of PVD is claudication, or pain in the calf. This is not just any pain. This is pain that is triggered by walking and relieved with rest, correlating with the fact that the leg muscles need more oxygen during exercise but are deprived of blood by the narrow arteries above. PVD should be suspected if such a relationship exists alongside coexisting risk factors for atherosclerosis.
Because of limited blood flow, PVD may also involve diminished pulses to the feet, which can be detected by physical examination or by measuring the blood pressure in both the arm and the ankle. A subtle but suggestive sign is the absence of hair over the lower extremities. The fact that hair follicles are not present means that blood flow to these cells is inadequate. With more severe PVD, portions of the foot may have gangrene.
Although PVD can be suggested by this clinical presentation, tests are done to confirm the diagnosis. One such test is Doppler ultrasound of the arteries in the lower extremities. Another test is an angiography, in which contrast dye is injected into the leg arteries and an x-ray image of the legs is taken. If the angiogram of the leg arterial circulation clearly has an area of narrowing with little to no blood flow beyond it, then the patient likely has PVD.
Treatment
First and foremost, patients with PVD must control all atherosclerotic risk factors, including diabetes, hypertension, hyperlipidemia, and smoking. Exercise is also important to train the legs, even if there is fear of worsening leg pain. Two medications, cilostazol and pentoxifylline, can help improve blood flow to the legs, but they are no substitute for the other options.
In more severe PVD, the treatment requires the expertise of a vascular surgeon. Options include bypass graft to provide a route of circulation around the arterial occlusion and endarterectomy to remove the occluding arterial plaque. In the worst case scenario, the affect leg would have to be amputated.
Final Words
Leg pain can be due to various causes, like trauma and lactic acid during vigorous exercise. However, if this pain occurs while walking or standing, is relieved with leg rest, and coexists with diabetes or other risk factors, a physician should determine whether peripheral vascular disease is the cause.
