Peripheral Vascular Disease (PVD)

Peripheral vascular disease (PVD) is a chronic disease process that occurs when a buildup of plaque and other substances blocks or narrows arteries, limiting or halting blood flow.

The term “peripheral vascular disease” is often used interchangeably with “peripheral artery disease” (PAD), but PVD can apply to any lymphatic or blood vessels, including veins, while PAD only applies to the arteries. When the arteries in the arms and legs become narrow or occluded due to the buildup of plaque, it eventually can lead to bouts of pain, or “leg attacks,” when you walk. PAD affects close to 12 to 15 million people in the U.S. It usually develops in patients 65 years or older but can be seen as early as 40 years of age. The most common causes of PAD include smoking, diabetes and kidney failure, among others.

The same artery blockages that cause PAD make people with the disease four to five times more likely to have a heart attack or stroke.

PVD Symptoms and Risk Factors

Many people with PVD don't have symptoms, but there are signs to watch for.

If you answer "yes" to one or more of these questions, you may benefit from an evaluation by a PVD specialist:

• Do you smoke or have you ever smoked?
• Have you been diagnosed with diabetes, chronic kidney disease, high blood pressure and/or high cholesterol?
• Do you have a family history of PVD?
• Have you ever been diagnosed with PVD, cardiac disease or stroke/mini-stroke?
• Do you ever experience tiredness, heaviness or cramping in the leg muscles, especially during activity?
• Do your toes and feet look pale, discolored or bluish?
• If you have leg pain, does it wake you up from sleep?
• Have you experienced sores or wounds on the toes, feet or legs that heal slowly or not at all?
• Does one leg or foot regularly feel colder than the other?
• Have you noticed poor nail growth and decreased hair growth over time on the toes or legs?

Some ways to help prevent PVD include the following:

• Quit smoking or do not start
• Eat a healthy diet
• Exercise
• Maintain a healthy weight

Peripheral Vascular Disease Treatment at RUSH

Since people with PVD may not experience symptoms, patients at high risk for the disease should get regular checkups. Early detection can help restore your mobility, decrease your risk of heart attack and stroke, and possibly save your life.

When it comes to PAD management, in particular, the overall goal is to make lifestyle changes, like quitting smoking, exercising more and sticking to a healthy diet, which can delay or prevent progression of the disease.

Our aim is to improve quality of life and avoid or delay procedures and surgeries. Even with the best medical care, PVD can progress to stages where interventional or surgical treatments may be needed. At RUSH, we work together across many specialties to create a personalized treatment plan for you.

Your treatment plan may include one or more of the following:

• Education on diet, exercise and other lifestyle factors that impact PVD
• Programs to quit smoking.
• Diabetes management
• Referral to a rehabilitation program for supervised exercise.
• Medications to lower blood pressure and/or cholesterol levels or minimize plaque buildup.
• Minimally invasive interventional therapies to restore blood flow if other management has failed or symptoms have advanced in a way that limits quality of life, including the following:
  • Balloon angioplasty, a minimally invasive procedure to increase blood flow to the legs using standard or several specialty balloons such as Intra Vascular Lithotripsy (IVL) for heavily calcified arteries.
  • Stenting, permanently implanted scaffolds to keep the artery open, when and where appropriate.
  • Atherectomy, an interventional technique for removing atherosclerosis from blood vessels in select cases.
• Bypass surgery or surgical removal of plaque may also be needed in complex cases to restore blood flow.

Critical Limb Ischemia/Chronic Limb Threatening Ischemia (CLI/CLTI)

Patients with PAD may present with different symptoms at various stages. At the earliest stage, most patients don't show symptoms. Later they may have calf, thigh or buttock pain when they walk a certain distance that resolves by resting, which is called intermittent claudication.

More advanced PAD patients may present with foot pain at rest or with wounds in the legs or feet that are not healing even with proper wound care, known as critical limb ischemia (CLI).

Those with diabetic foot ulcers (DFU) make up the largest portion of patients who develop CLI, and the condition is one of the biggest and costliest burdens to the U.S. healthcare system. Limb loss is the main concern for patients who reach critical limb ischemia level of PAD.

The diagnosis of CLI also carries a higher mortality rate — greater than 60% in 5 years — than many of the cancers known to the public, especially in patients who lose the ability to walk after a major amputation. There are widespread gender, racial and geographic inequalities in limb loss.

Treatment typically focuses on managing diabetes, making lifestyle changes — exercising, quitting smoking and staying on a healthy diet — along with regular wound care and improving or restoring blood flow when appropriate. With early detection and management, proper wound care and treatment at experienced centers with skilled interventionalists can often avoid major and minor amputations.

We routinely offer screenings to our patients coming to cardiology, interventional radiology and vascular surgery clinics. If a screening confirms PAD, the patient will be referred to our dedicated PAD clinic, where testing will be carried out and therapy will be recommended.

Abdominal Aortic Aneurysm (AAA)

The aorta is the main blood vessel that carries blood from the heart to the rest of the body. It is called the "abdominal aorta” while it courses below the diaphragm. The dilation, or ballooning, of this big artery is called Abdominal Aortic Aneurysm (AAA). Because the aorta is the largest blood vessel in the body, a ruptured abdominal aortic aneurysm causes life-threatening bleeding.

All men 65 years of age or older who are current or former smokers, as well as people with a family history of abdominal aortic aneurysms, are eligible for screening.

Depending on the size of the aneurysm and how fast it is growing, treatment varies from watchful waiting to elective endovascular repair to emergency surgery. At RUSH, specialists perform repairs mostly by minimally invasive procedures through tiny incisions.

Rush Excellence in Peripheral Vascular Disease

• Care close to home: The Peripheral Artery Disease Clinics at RUSH University Medical Center and RUSH Oak Park Hospital offer comprehensive care to manage symptoms, keep the disease from worsening and reduce future risk. This includes diagnostic testing, a full range of treatments, education, supervised exercise and smoking cessation.
• Limb preservation expertise: Being told that amputation is your only treatment option can be devastating, and many patients with PVD who are at CLI stages hear it. Aside from having all advanced treatment technologies available, what makes RUSH stand out is the training and experience level of our interventional physicians. Having performed thousands of arterial interventions with over 95% success rates in reopening blocked or narrowed arteries, we can provide excellent outcomes to many patients who look for a second or even third opinions to preserve their legs. Learn more on our Limb Preservation Services page.
• Groundbreaking research, treatments: Specialists at RUSH are leaders in research on peripheral vascular disease, so they are able to offer patients many new treatments before they are widely available. Our Vascular Interventional Radiology team regularly participates in clinical trials that show great promise, even for patients who've been deemed as having “no option” and are facing major amputation. These trials are paving the way for techniques that give patients the best outcomes without the negative side effects of many current treatments that are widely used.