By Jose L. Trani, MD
Vascular Surgeon, Cooper University Health Care
In fact, pain experienced in the legs while walking could be a symptom of a very common circulatory condition that is difficult to diagnose. When plaque builds up in any of the blood vessels outside of the heart, such as in the arteries, veins or lymphatic vessels, the result is peripheral vascular disease (PVD). This condition is also referred to as peripheral arterial disease (PAD).
PVD slowly and steadily restricts your circulation, and it is dangerous if left untreated.
The main cause of PVD is plaque buildup (atherosclerosis) in a leg artery. This buildup of cholesterol, calcium and fibrous tissue, either partially or completely, blocks blood flow to parts of the body other than the heart, such as the legs and arms.
Due to the fact that narrowed blood vessels cannot carry oxygen-rich blood to these other body parts, the circulation stops functioning properly. Additionally, blood clots may form on an artery wall, narrowing the artery even further and making the blockage worse.
The risk factors for peripheral vascular disease include conditions that cannot be controlled as well as lifestyle habits and health issues that are controllable. Risk factors that cannot be changed are:
• Being over age 50.
• History of heart disease.
• Type 1 diabetes.
• Being male (men are at greater risk than women).
• Being postmenopausal.
• Family history of high cholesterol, high blood pressure or peripheral vascular disease.
Risk factors that can be reduced or controlled include:
• Smoking and/or use of other tobacco products.
• Heart disease.
• High cholesterol.
• High blood pressure.
• Being overweight.
• Lack of exercise.
The challenge of identifying PVD early is that many individuals who have it do not experience any symptoms. Approximately 50 percent of people correctly diagnosed with peripheral vascular disease are symptom free.
The most common warning sign of PVD is lower-leg pain when walking, climbing stairs or exercising. Another warning sign instead of feeling pain, is that you may experience heaviness, tightness, weakness or cramping in the legs when walking. This is called intermittent claudication—a painful tightening in the calf muscle. It’s all too easy to assume the pain indicates something other than a circulatory problem. While at rest, the muscles need less blood flow, so the pain goes away. A variety of non-vascular sources of leg pain can make it difficult to determine what the discomfort is telling you, including:
While not as common as leg pain, these may also be warning signs of peripheral vascular disease:
• Changes in skin temperature and appearance (especially brittle, shiny skin on the legs and feet).
• Loss of leg hair.
• Non-healing sores over pressure points (heels, ankles).
• A reddish-blue skin color on the legs.
To determine if someone has PVD, a doctor will most likely check for a weak or absent leg pulse. This may reveal a blockage in the leg artery. Other non-invasive tests used to confirm blockage and a diagnosis of peripheral vascular disease are checking leg blood pressure, a CT scan or magnetic resonance angiography (MRA), and ultrasound.
Once the diagnosis is confirmed, your doctor will decide the best treatment based on your symptoms. Severe symptoms can prompt a vascular surgeon to discuss restoring blood flow to the legs. Improved circulation should lessen and eliminate leg pain. However, the majority of patients do not require a procedure to restore flow. Lifestyle changes are typically first suggested as proactive ways to manage PVD’s risk factors. Patients can actually improve their walking with conservative measures.
Whether suggested proactively or as a treatment plan to reduce the progress of peripheral vascular disease, expect the following recommendations from your doctor:
• Quit smoking (also avoid second-hand smoke and use of other tobacco products).
• Eat foods low in saturated fat.
• Lose weight and maintain a healthy body weight.
• Begin or continue with an exercise program that includes walking several times a week.
• Drink less alcohol.
• Control high cholesterol through medication (per doctor’s recommendation).
• Use medication to reduce the risk of blood clots developing (per doctor’s recommendation).
• Monitor and control type 1 diabetes, maintain healthy blood sugar levels.
• Monitor and control high blood pressure.
If lifestyle changes and/or medication don’t improve blood flow and leg function, your vascular surgeon may consider other forms of treatment. Minimally invasive procedures include:
• Inflating and deflating a special balloon in the leg artery to push the plaque out of the way (angioplasty).
• Inserting a stent to keep the artery open.
• Breaking up and removing plaque from the blood vessels (endarterectomy).
If peripheral vascular disease is severe enough, creating a detour around the narrowed or blocked artery area with bypass surgery may be necessary.
Leaving PVD undiagnosed and untreated can lead to serious issues such as constant pain, development of ulcers or dead tissue (gangrene), and possible amputation of toes or a small part of the foot. PVD also increases the risk of heart disease and stroke.
With early detection and proper treatment of peripheral vascular disease, it’s possible to maintain a good quality of life and long-term good health. If you’re over the age of 50 and have lower-leg pain when walking, climbing stairs or exercising, do not ignore it. Make an appointment to see your doctor and request an evaluation with a vascular surgeon.