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Peripheral vascular disease

With peripheral arterial disease (PAD), also called peripheral vascular disease (PVD), deposits of fat build-up in the arteries restricting the blood supply to the leg muscles. This process is called atherosclerosis.

PAD is more common with age and affects around 1 in 5 over 70s. Men tend to develop PAD earlier than women.

PAD may not cause any symptoms, but can cause pain in the legs after walking.

Complications of PAD include heart attack, stroke or critical limb ischaemia (CLI) where blood flow to the limbs is severely restricted.

Other PAD symptoms

PAD pain can be mistaken for something else.

Other signs and symptoms of peripheral artery disease include:

  • Wounds that heal poorly
  • Legs are cooler than the arms
  • Shiny skin over the legs
  • Loss of hair on the legs
  • Decreased pulses in the feet.
  • Leg ulcers
  • Brittle toenails

PAD diagnosis

Doctors will ask about PAD symptoms, carry out a physical examination and measure the ankle-brachial index (ABPI). This is done using a handheld ultrasound probe to measure the blood pressure at the ankle and upper arm. A difference in the readings may suggest PAD.

Referral to hospital may be needed for further testing. Tests include ultrasound scans or angiograms of the legs to pinpoint blockages in the arteries.

Causes of peripheral vascular disease

The most common type of peripheral vascular disease is peripheral artery disease.

  • Peripheral artery disease is due to atherosclerosis. This is a gradual process in which a fatty material builds up inside the arteries.
  • The fatty material mixes with calcium, scar tissues, and other substances and hardens slightly, forming atherosclerotic plaques.
  • These plaques block, narrow, or weaken the vessel walls.
  • Blood flow through the arteries can be restricted or blocked totally.

Other causes of peripheral vascular disease include the following:

  • Blood clot: A blood clot can block a blood vessel (thrombus/emboli).
  • Diabetes: Over the long term, the high blood sugar level of those with diabetes can damage blood vessels. This makes the blood vessels more likely to become narrowed or weakened. Additionally, people with diabetes frequently also have high blood pressure and high fats in the blood, which accelerates the development of atherosclerosis.
  • Inflammation of the arteries: This condition is called arteritis and can cause narrowing or weakening of the arteries. Several autoimmune conditions can develop vasculitis, and, as well as the arteries, other organ systems are also affected.
  • Infection: The inflammation and scarring caused by infection can block, narrow, or weaken blood vessels. Both salmonellosis (infection with Salmonella bacteria) and syphilis have been two infections traditionally known to infect and damage blood vessels.
  • Structural defects: Defects in the structure of a blood vessel can cause narrowing. Most of these cases are acquired at birth, and the cause remains unknown. Takayasu disease is a vascular disease affecting the upper vessels of the body and affects (usually Asian) females.
  • Injury: Blood vessels can be injured in an accident such as a car crash or a bad fall.

People who have coronary heart disease or a history of heart attacks or strokes generally also have an increased frequency of having peripheral vascular disease.

Only about half of the people with peripheral vascular disease have symptoms. Almost always, symptoms are caused by the leg muscles not getting enough blood. Whether you have symptoms depends partly on which artery is affected and to what extent blood flow is restricted.

The most common symptom of peripheral vascular disease in the legs is pain in one or both calves, thighs or hips.

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