Peripheral Vascular Disease Has Many Treatment Options

Craig Siverhus, M.D., General & Vascular Surgeon, Columbia St. Mary’s

Posted: Feb. 1, 2007

Hardening of the arteries, otherwise known as atherosclerosis, occurs when an artery in the lower half of a person’s body becomes severely blocked due to any number of factors. These hardened arteries often lead to a very serious and today widespread disease called peripheral vascular disease (PVD).

PVD causes arteries in the abdomen and legs to become blocked by a buildup of plaque. This buildup causes blood flow to be restricted to these parts of the body, resulting in a loss of oxygen supplied to the tissue. The lack of oxygen can cause persistent leg pain when a person is walking or pain in the top of the foot when a person is at rest. This pain is often the first sign of PVD.

PVD can progress beyond simple leg pain and can lead to gangrene or ulcers of the skin on the foot, or ultimately leg amputation if it is left untreated. People with high blood pressure, high cholesterol, diabetes, or those who smoke are most at risk for developing this disease. A person who has one of these risk factors and begins experiencing chronic leg pain should visit a doctor as soon as possible for evaluation.

Typically the first step in diagnosing PVD is a thorough history and physical, including examining a patient for other PVD symptoms such as loss of pulse in the feet or groin, any skin changes, the loss of hair on the legs, or feet turning red while sitting. An ankle brachial index test may also be performed, in which the blood pressure readings in a patient’s arms and ankles is taken and compared to determine if there is a lack of blood flow to the legs.

A magnetic resonance angiogram, similar to an MRI, or a classic angiogram may also be used to examine a patient’s blood vessels and determine the amount of blockage. During an angiogram, dye is injected into the blood vessels which allows a physician to see where blood is flowing and where it is blocked.

Once PVD is diagnosed, there are fortunately a number of treatment options available to help control this disease. For most people, lifestyle modification, such as smoking cessation or a regular exercise program, may be all that is needed. Often these changes, along with lowering high blood pressure or high cholesterol, are all that is necessary to manage PVD. However, if it persists, medication is also an option.

For advanced stages of PVD, or for PVD that does not respond to more conservative treatments, surgical interventions are available. Bypass surgery, using the patient’s own blood vessel or a synthetic material, can reroute blood around the blockage. Angioplasty, with or without stenting, also is available for larger blood vessels, although through technological advancements in equipment, this technique is now being used in smaller blood vessels.

Patients who have PVD often have other vascular issues, particularly coronary artery disease. At the Vascular Institute at Columbia St. Mary’s, we have pulled together a team of specialists that include cardiologists, interventional radiologists and surgeons who evaluate each patient to develop the most appropriate plan of care.

Craig Siverhus, M.D.
General Surgeon
Columbia St. Mary’s
414-961-VASC

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