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The Peripheral Artery Disease Treatment Program at the Massachusetts General Hospital Fireman Vascular Center provides specialized diagnosis and treatment options as well as ongoing care for patients with peripheral artery disease of the extremities.
Peripheral Vascular Disease
What is peripheral vascular disease?
Peripheral vascular disease (PVD) is a slow and progressive circulation disorder caused by narrowing, blockage, or spasms in a blood vessel.
PVD may involve disease in any of the blood vessels outside of the heart including the arteries, veins, or lymphatic vessels. Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.
The terms "peripheral vascular disease" and "peripheral arterial disease" are often used interchangeably.
What causes peripheral vascular disease?
PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis, the buildup of plaque inside the artery wall. Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.
Other causes of peripheral vascular disease may include:
- Injury to the arms or legs
- Irregular anatomy of muscles or ligaments
People with coronary artery disease often also have peripheral vascular disease.
Who is at risk for peripheral vascular disease?
A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history, or many other things. Risk factors for peripheral vascular disease include factors which can be changed or treated and factors that cannot be changed.
Risk factors that you can’t change:
- Age (especially older than age 50)
- History of heart disease
- Male gender
- Postmenopausal women
- Family history of high cholesterol, high blood pressure, or peripheral vascular disease
Risk factors that may be changed or treated include:
- Coronary artery disease
- High blood sugar
- High cholesterol
- High blood pressure
- Physical inactivity
- Smoking or use of tobacco products
Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow.
What are the symptoms of peripheral vascular disease?
Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the clogged or narrowed artery.
Other symptoms of peripheral vascular disease may include:
- Changes in the skin, including decreased skin temperature, or thin, brittle shiny skin on the legs and feet
- Diminished pulses in the legs and the feet
- Gangrene (dead tissue due to lack of blood flow)
- Hair loss on the legs
- Non-healing wounds over pressure points, such as heels or ankles
- Numbness, weakness, or heaviness in muscles
- Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
- Pallor (paleness) when the legs are elevated
- Reddish-blue discoloration of the extremities
- Restricted mobility
- Severe pain when the narrowing of the artery is significant or totally blocked
- Thickened, opaque toenails
The symptoms of peripheral vascular disease may resemble other conditions. Consult your physician for a diagnosis.
How is peripheral vascular disease diagnosed?
In addition to a complete medical history and physical exam, other tests may include:
- Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing of the vessels. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
- Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.
- Doppler ultrasound flow studies. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Doppler technique is used to measure and assess the flow of blood. Faintness or absence of sound may indicate an obstruction in the blood flow.
- Magnetic resonance angiography (MRA). This noninvasive diagnostic procedure uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within the body. An MRA is often used to examine the brain and other soft tissues and to assess blood flow.
- Treadmill exercise test. This test is given while a patient walks on a treadmill to monitor circulation during exercise.
- Photoplethysmography (PPG). This exam is comparable to the ankle brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements. These measurements are then compared to the systolic blood pressure in the arm.
- Pulse volume recording (PVR) waveform analysis. This technique is used to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.
- Reactive hyperemia test. This test is similar to an ABI or a treadmill test but used for people who are unable to walk on a treadmill. While a person is lying on his or her back, comparative blood pressure measurements are taken on the thighs and ankles to determine any decrease between the two sites.
What is the treatment for peripheral vascular disease?
The main goals for treatment of peripheral vascular disease are to control the symptoms and halt the progression of the disease to lower the risk for heart attack, stroke, and other complications.
Specific treatment will be determined by your health care provider based on:
- Your age, overall health, and medical history
- Extent of the disease
- Your signs and symptoms
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Treatment may include:
- Lifestyle changes to control risk factors, including regular exercise, proper nutrition, and smoking cessation
- Aggressive treatment of existing conditions that may worsen PVD, such as diabetes, high blood pressure, and high cholesterol
- Medications for improving blood flow, such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls
- Vascular surgery —a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow
- Angioplasty — a catheter (long hollow tube) is used to create a larger opening in an artery to increase blood flow. Angioplasty may be done in many of the arteries in the body. There are several types of angioplasty procedures, including:
- Balloon angioplasty (a small balloon is inflated inside the blocked artery to open the blocked area)
- Atherectomy (the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter)
- Laser angioplasty (a laser is used to "vaporize" the blockage in the artery)
- Stent (a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open)
With both angioplasty and vascular surgery, an angiogram is often done before the procedure.
What are the complications of peripheral vascular disease?
Complications of peripheral vascular disease most often occur because of decreased or absent blood flow. Such complications may include:
- Amputation (loss of a limb)
- Poor wound healing
- Restricted mobility due to pain or discomfort with exertion
- Severe pain in the affected extremity
- Stroke (three times more likely in people with PVD)
By following an aggressive treatment plan for peripheral vascular disease, complications such as these may be prevented.
Can I prevent peripheral vascular disease?
Steps to prevent PVD are primarily aimed at management of the risk factors for PVD. A prevention program for PVD may include:
- Smoking cessation, including avoidance of second hand smoke and use of any tobacco products
- Dietary changes including reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables, low-fat dairy, and lean meats
- Treatment of high blood cholesterol with medications as determined by your health care provider
- Weight reduction
- Moderation in alcohol intake
- Medications as determined by your health care provider to reduce your risk for blood clots
- Exercise plan of a minimum of 30 minutes daily
- Control of diabetes
- Control of high blood pressure
A prevention plan for PVD may also be used to prevent or lessen the progress of PVD once it has been diagnosed. Consult your doctor for diagnosis and treatment.
Living with peripheral vascular disease
It’s important to follow your health care provider’s recommendation for managing PVD to manage the symptoms and stop the disease from progressing.
When should I call my health care provider?
If your symptoms get worse or you get new symptoms, let your health care provider know.
- Peripheral vascular disease affects all types of blood vessels.
- Blood flow is restricted to the tissue because of spasm or narrowing of the vessel.
- This disease more often affects the blood vessels in the legs.
- The most common symptom is pain, which becomes worse as the circulation more limited.
- Treatment is focused on restoring the blood flow and preventing disease progression.
Tips to help you get the most from a visit to your health care provider:
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Providing patient education during PAD Awareness Month - 8/26/2015, Mass General
Each September, the MGH recognizes PAD Awareness month to educate the public about this little known disease. Michael R. Jaff, DO, answers some commonly asked questions.
Providing patient education during PAD Awareness Month - 8/26/2015, Mass General
Each September, the MGH recognizes PAD Awareness month to educate the public about this little known disease. Michael R. Jaff, DO answers some commonly asked questions.
First U.S.-based trial supports the effectiveness of a drug-coated balloon for patients with PAD - 8/5/2015, Mass General
In January 2015, the U.S. FDA approved the use of a drug-coated balloon to treat peripheral artery disease (PAD) based on research spearheaded by Kenneth Rosenfield, MD, and Michael R. Jaff, DO.
Patient Spotlight: Understanding PAD - 10/6/2008, Mass General
Eugene Tarsky, 73, had never heard of peripheral artery disease (PAD) when he was first diagnosed three years ago. Though the news was troubling, careful monitoring by doctors and a commitment to reducing his risk factors have kept him healthy and free from complications.
Pushing through the miles and beating vascular disease - 10/2/2008, Mass General
Every year Janice Williams, a 41-year-old dental assistant, runs a 10K to support breast cancer research. In 2001, she finished the race in just 46 minutes, 53 seconds. In 2006, her finishing time slowed down to over 1 hour, 7 minutes.
Patient Spotlight: Understanding PAD - 10/1/2008, Clinical
Man gets walking to improve blood flow and overall health - 10/1/2008, Mass General
Eugene Tarsky, 73, had never heard of peripheral artery disease (PAD) when he was first diagnosed three years ago. But careful monitoring by doctors and a commitment to reducing his risk factors have kept him healthy and free from complications.
The Division of Vascular and Endovascular Surgery at Massachusetts General Hospital provides leading vascular and endovascular surgical care.
When you exercise, you'll breathe faster and more deeply. This maximizes the amount of oxygen in your blood.
Many vascular conditions can be improved by changing certain lifestyle factors. Maintaining a healthy weight is one of many factors. If you are trying to make heart-healthy changes to your diet, it is helpful to know some basics about nutrition, starting with the components of food.
Diseases caused by smoking kill more than 437,900 people in the United States each year. Around 35 percent of these deaths were cardiovascular related.
CNN segment on Peripheral Arterial Disease featuring Dr. Michael Jaff
Dr. Michael Jaff, Medical Director of the Massachusetts General Hospital Fireman Vascular Center, is featured in a CNN segment on Peripheral Arterial Disease.
Talk with your doctor about peripheral artery disease
Deborah Hines, NP, encourages talking with your doctor about peripheral artery disease, a circulatory condition in which arteries narrowed by atherosclerosis reduce blood flow to the limbs, particularly to the legs and arms.
Recognize the symptoms of peripheral artery disease
Michael Jaff, DO, encourages the public to recognize the symptoms of peripheral artery disease, a circulatory condition in which arteries narrowed by atherosclerosis reduce blood flow to the limbs, particularly to the legs and arms.
Michael Jaff, DO, discusses diabetes and its potential complications, such as peripheral artery disease
Michael Jaff, DO, Medical Director of the Massachusetts General Hospital Fireman Vascular Center, says that if you have diabetes, your odds are 1 in 3 of developing peripheral artery disease, with potentially serious consequences. Learn more about why peripheral artery disease often goes undetected, and how it can be diagnosed and treated.
Prevailing over PAD: Jim's Story
Jim O’Brien started to experience pain in his legs and difficulty walking, even short distances. He visited Dr. Douglas Drachman at Mass General, who diagnosed him with peripheral artery disease (PAD). While treating Jim for PAD, Mass General found and diagnosed him with liver cancer. The team of doctors collaborated closely to balance the treatment of both diseases.