• Peripheral Vascular Disease (PVD)

    An Overview of Peripheral Vascular Disease

    Kevin Raftery, MD, and Edward Jewell, MD, consulting on a peripheral vascular disease (PVD) caseA number of patients suffer from peripheral vascular disease (PVD), which is a hardening of the arteries resulting in lower extremity blockages. Symptoms range from pain while walking to limb-threatening problems.

    Pain while walking is typically the first PVD symptom patients experience. Patients usually report pain in a muscle group such as their calf or thigh after walking a certain distance. If the patient stands and rests for a few minutes, the pain goes away, but as he/she walks faster, symptoms occur more rapidly. This trend is called “claudication” and is a benign disease.

    On average, if a doctor follows 20 patients with claudication for five years, only one will end up with a limb-threatening problem. Most patients with claudication can be managed conservatively by controlling all of their risk factors. Cholesterol, high blood pressure and diabetes should all be controlled, and tobacco use (if any) should be discontinued. In addition, patients with claudication should be placed on an exercise program, in the hopes that faithfulness to the routine will double the distance they can walk within approximately three months.

    Most importantly, patients should take excellent care of their feet. As their disease progresses, if they get a cut on their foot, it might not heal properly, and they will need to have bypass surgery in order to save the limb. Patients with peripheral vascular disease should never walk barefoot, and they should be careful about cutting their toenails, wearing new shoes and soaking their feet in hot or cold water. Since claudication is a benign disease with symptoms that can be alleviated through an exercise program, at Lahey we are generally quite conservative with our therapy.

    Peripheral Vascular Disease Treatment at Lahey

    Non-Surgical (Endovascular) Options

    Peripheral Vascular Interventions
    Peripheral vascular intervention procedures help to open blockages in peripheral arteries and restore blood flow to the lower body, legs or kidneys. If it is determined that a blockage is causing an obstruction, angioplasty is performed. Angioplasty involves inflating a tiny balloon within the obstructed artery in order to open the narrowed area. After angioplasty, one or more stents may be placed to keep the artery open.

    Cerebrovascular Interventions
    Cerebrovascular interventions are conducted to open blockages in cerebral arteries (arteries to the brain). These procedures help to restore blood flow in the brain, thus reducing the risk of major stroke. During cerebrovascular intervention, a team of physicians – including an interventional cardiologist, interventional neuroradiologist, neurologist, and vascular surgeon – direct patient care. The actual procedure is performed jointly by the interventional cardiologist and interventional neuroradiologist. If an obstructive blockage is found, angioplasty is performed to open it using a tiny balloon. Following angioplasty, a stent may be used to keep the artery open.

    Surgery

    For patients with limb-threatening problems, Lahey's vascular surgeons feel invasive therapy is generally the best option. Symptoms of limb-threatening problems include rest pain (pain while at rest), non-healing ulcers and gangrene. Patients with rest pain report pain in their toes at night that causes them to wake up. The pain is relieved by hanging the foot over the side of the bed or going for a short walk. Non-healing ulcers are frequently caused by trauma, and they typically do not heal due to an insufficiency in blood supply. Gangrene is a black area of growth on the skin that generally progresses slowly. If the area is infected, gangrene can progress more rapidly.

    Our first choice is to treat patients with a balloon angioplasty and/or stents, which is sometimes adequate therapy. If not, surgical bypass is the next best option and is typically required for patients with peripheral vascular disease. Approximately 98 percent of limb-threatening problems can be fixed with bypass surgery, which can be performed with a 1 percent mortality rate. Bypass grafts have a failure rate per year of approximately 4 to 5 percent, though this rate is much higher in patients who smoked prior to surgery and continue to do so afterward.  

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