Peripheral vascular disease (PVD) affects the arteries, the veins or the lymph vessels. The most severe type of PVD is peripheral artery disease (PAD).
At the Washington University and Barnes-Jewish Heart & Vascular Center, we assess and treat PAD and other vascular diseases. Using highly specialized surgery, we can restore blood flow and keep your legs and feet healthy.
What Is Peripheral Vascular Disease?
Vascular diseases affect the veins and arteries that carry blood to and from your heart. Peripheral vascular disease affects the vessels in your legs, arms, stomach or kidneys. Most often, people experience PAD symptoms in their legs.
In PAD, atherosclerosis (hardening of the arteries) causes the blood vessels to narrow. These narrowed vessels restrict the amount of oxygen and nutrients that flow to your limbs and organs. This disease process is similar to coronary artery disease and carotid artery disease.
Getting an accurate diagnosis is essential. Patients with PAD are four to five times more likely to have a heart attack or stroke. PVD can also lead to clots that can cause deep venous embolism or pulmonary embolism. Learn more about the vascular diseases we treat.
Symptoms and Complications of Peripheral Vascular Disease
The most common early sign of PAD is pain at the end of the day or when walking any distance. This pain is known as claudication.
As reduced blood flow becomes more severe, patients may experience critical limb ischemia. Symptoms of this more serious form of PAD may include:
- constant pain
- numbness or tingling
- nonhealing sores
- gangrene (tissue death due to lack of blood flow), often in the feet
Medical care is essential for critical limb ischemia. If you lose blood flow for a long time, you may need to have a diseased toe, foot or leg amputated. But with the right care, our Limb Preservation Center may be able to restore blood flow and save your leg.
Risk Factors for Peripheral Vascular Disease
More than 10 million people in the United States have PAD. By age 65, about 10 percent to 15 percent of the population has PAD.
The likelihood of PAD increases with:
- advanced age
- end-stage renal disease
- high blood pressure
- high cholesterol
Diagnosing Peripheral Artery Disease or Peripheral Vascular Disease
Tests to diagnose PAD or PVD in the legs may include:
- physical exam to check pulse strength in your legs and feet and examine any signs of sores or gangrene
- ankle-brachial index (ABI) to measure your resting blood pressure at your ankle and wrist
- Doppler ultrasound, a painless test using sound waves to measure the thickness of blood vessels and the rate of blood flow
- angiography, using a CT scan or MR scan and injected dye to view blood flow in your legs and locate areas where blood vessels are narrowed or blocked
Peripheral Artery Disease Treatment
Treatments for PAD and PVD often begin with home care supervised by your doctor. We typically recommend:
- lifestyle changes, such as a healthy diet
- walking for exercise
These changes cannot end the narrowing of arteries in the legs. But they can help improve the efficiency of your heart and leg muscles. As a result, you may experience fewer symptoms such as leg pain, cramping and weakness.
Our vascular surgeons also work closely with your primary care physician and cardiologist to track your health. Patients diagnosed with PAD or PVD have a higher risk of stroke and heart attack. We work with your healthcare team to control your cardiovascular risk factors.
Minimally invasive procedures for PAD or PVD
Vascular surgeons at the Washington University and Barnes-Jewish Heart & Vascular Center are nationally recognized for their skill in minimally invasive procedures.
Our surgeons can restore blood flow to arteries in the legs by working through a slender catheter (tube) placed in the artery at the groin or the elbow. We perform many of these procedures on an outpatient basis. Most people experience minimal discomfort and a short recovery time. Learn more about the vascular surgery options we offer.
Your treatment options for PAD or PVD may include:
- atherectomy devices, catheter-based tools to clean away plaque, open arteries and veins and remove blockages
- stent and covered-stent placement, tiny mesh tubes that we implant using a slender catheter to reopen an artery or vein
- drug-coated stents that we implant in the thigh artery, where they release medication to prevent clotting and blockages
- percutaneous transluminal angioplasty (PTA or balloon angioplasty) to clear away blockages
Surgery for PAD or PVD
At times, people need traditional surgery to correct severe, extensive blockages of the pelvic and leg arteries. Procedures may include:
- Bypass surgery: Your surgeon closes off the blocked artery to stop problematic blood flow. Then the surgeon reroutes blood flow through a superficial leg vein or an artificial vein. The new vein redirects blood flow around the blockages in the leg arteries.
- Combined procedure: We use both open surgical and minimally invasive endovascular techniques. This way, we can restore blood flow to your leg and foot with a shorter, more comfortable recovery.
- Arterialization: We use selective arterialization if you do not have enough healthy blood vessels in the foot for a bypass. In this highly specialized surgery, we convert veins into arteries by rerouting blood flow into healthy, unblocked blood vessels.
- Reconstructive surgery: We use reconstructive techniques to cover a wound or sore that will not heal otherwise. We may use tissue taken from elsewhere in the body, which may have enough healthy blood vessels for arterialization. Read more about arterialization and reconstructive surgery to avoid amputation.
Your PAD Care Team
Effective treatment of PAD and critical limb ischemia requires a team of caregivers. At the Heart & Vascular Center’s multidisciplinary Limb Preservation Center, you can access experts from many medical disciplines. Together, we provide all of the answers and care you need. Our goal is to help you maintain your comfort, mobility and independence.
Your team may include:
- vascular surgeons with endovascular and surgical skills
- endocrinologists (specialists in the hormone system and diabetes)
- podiatrists (foot specialists)
- plastic surgeons who specialize in reconstructive techniques
- wound care specialists
- rehabilitation therapists
Research and Clinical Trials for PAD or PVD
Our surgeons lead clinical trials exploring the latest techniques for endovascular treatment and drug therapy for PAD and PVD. You may have access to investigational therapeutic options that are not ordinarily available. Other research opportunities seek to develop new knowledge to help future patients. Learn more about our innovation.
To make an appointment with a Washington University vascular specialist at Barnes-Jewish Hospital, call 314-273-7373.