Peripheral Vascular Disease
What is Atherosclerosis or PVD?
Disease or conditions which commonly affect the blood vessels include atherosclerosis (hardening of the arteries), diabetic circulatory problems, and vascular graft malfunction or occlusion. Patients may typically experience an aching in their legs when they walk and need to stop and rest their legs after a short walk (claudication), non-healing sores on their toes or ankles, leg pain or cramping at night while they sleep, or even gangrene.
How is PVD evaluated?
Patients are initially evaluated in our vascular clinic. Some patients may benefit from a non-invasive duplex vascular exam prior to angiographic evaluation. Many diseases that affect the blood vessels, both arteries and veins, can only be adequately imaged using radiographic contrast ("dye") that is injected through a small catheter placed directly within the vessel. This is performed by an interventional radiologist.
The interventional radiologist is specially trained to access the arteries in the legs or almost any part of the body relatively painlessly in order to obtain high quality diagnostic images of the area in question. Once the diagnostic portion of the exam is completed, the results will be discussed with you and your referring physician so that you can make an educated decision as to which treatment option best meets your needs and desires.
How can PVD be treated?
Diseases of the blood vessels typically are manifested as either stenoses (narrowings) or occlusions (blockages). Many of the lesions can be treated without surgery using catheters just slightly larger than those used for the diagnostic examination.
Percutaneous transluminal angioplasty (PTA) is a technique in which a small balloon on a catheter is inserted across the narrowing or blockage, inflated to open the area, and removed. If the lesion does not respond well to PTA, then a small metal tube called a vascular stent, can be inserted to act as a scaffold to support the vessel. If blood clots are present, then a clot dissolving medicine called urokinase can sometimes be used ("thrombolysis") before further treatment is planned.
These non-surgical options for treatment are tailored to each individuals needs. In many cases they can be performed instead of surgery, but they are also commonly used in conjunction with surgery to optimize the patient's results. All patients will receive follow-up in our vascular clinic, detailed counseling on an exercise program designed to improve your walking endurance, and consultation by expert physicians from the Lipid Clinic for those with hypercholesterolemia (high fat levels in the blood).
Are you at risk for Peripheral Vascular Disease (PVD)?
Your answers to these questions will help you know if you are at risk.
- Do you have cardiovascular (heart) problems such as high blood pressure, heart attack, stroke?
- Do you have diabetes?
- Do you have a family history of diabetes or cardiovascular problems (immediate family such as parent, sister, brother)?
- Do you have aching, cramping or pain in your legs when you walk or exercise, but then the pain goes away when you rest?
- Do you have pain in your toes or feet at night?
- Do you have any ulcers or sores on your feet or legs that are slow in healing?
- Do you smoke?
- Have you ever smoked?
- Are you more than 25 pounds overweight?
- Do you eat fried or fatty foods three times a week or more?
- Do you have an inactive lifestyle?
The more "Yes" answers you have, the more important it is for you to see your doctor.
How can I find out more information?
If you suspect that you may have PVD, it is important that you see your personal physician for an evaluation. If you are concerned about PVD, you can take the following self-test to determine if you are at risk. You also may want to participate in Legs For Life™ — National Screening for PVD Leg Pain. To find out about a Legs for Life screening program near you, click here.
If you are interested in coming Johns Hopkins Hospital for these procedures, please feel free to contact us.
