Vascular and Endovascular Surgery

Peripheral Vascular Disease

Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart and diseases of the lymph vessels - the arteries, veins, or lymphatic vessels. Organs supplied by these vessels such as the brain, heart, and legs, may not receive adequate blood flow for ordinary function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

Conditions associated with PVD that affect the veins include deep vein thrombosis (DVT), varicose veins, and chronic venous insufficiency. Lymphedema is an example of PVD that affects the lymphatic vessels.

PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis (the buildup of plaque inside the artery wall). Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.

Other causes of peripheral vascular disease may include trauma to the arms or legs, irregular anatomy of muscles or ligaments, or infection. Persons with coronary artery (arteries that supply blood to the heart muscle) disease are frequently found to also have peripheral vascular disease.

What are conditions associated with peripheral vascular disease?

The term "peripheral vascular disease" encompasses several different conditions. Some of these conditions include, but are not limited to, the following:

• Atherosclerosis - the build-up of plaque inside the artery wall. Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. The artery wall then becomes thickened and loses its elasticity. 
• Buerger's Disease (thromboangiitis obliterans) - a chronic inflammatory disease in the peripheral arteries of the extremities leading to the development of clots in the small- and medium-sized arteries of the arms or legs and eventual blockage of the arteries.  
• Chronic Venous Insufficiency - a prolonged condition in which one or more veins do not adequately return blood from the lower extremities back to the heart due to damaged venous valves. 
• Deep Vein Thrombosis (DVT) - a clot that occurs in a deep vein, and has the potential to dislodge, travel to the lungs, occlude a lung artery (pulmonary embolism), and cause a potentially life-threatening event. It is found most commonly in those who have undergone extended periods of inactivity, such as from sitting while traveling or prolonged bed rest after surgery.
• Raynaud's Phenomenon - a condition in which the smallest arteries that bring blood to the fingers or toes constrict (go into spasm) when exposed to cold or as the result of emotional upset. Raynaud's most commonly occurs in women between the ages of 18 and 30.
• Thrombophlebitis - a blood clot in an inflamed vein, most commonly in the legs, but it can also occur in the arms. The clot can either be close to the skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis). It may result from pooling of blood, venous wall injury, and altered blood coagulation.
• Varicose Veins - dilated, twisted veins caused by incompetent valves (valves that allow backward flow of blood) allowing blood to pool. It is most commonly found in the legs or lower trunk. 

Diagnosing peripheral vascular disease using pulse volume recording

Pulse Volume recording is an easy, non-invasive and accurate way to diagnosis and measure the blood flow within the blood vessels or arteries. Its purpose is to help locate blockages in the arteries. Physicians usually perform pulse volume recording on the legs to help diagnose leg artery disease. However, pulse volume recording may also be used in patients with suspected arm artery disease, thoracic outlet syndrome, or spasms of the finger arteries (Raynaud's disease).

For the ABI, your physician measures your blood pressure in your ankle and in your arm. Your physician will compare the two numbers to determine your ABI. The ankle-arm pressure index (also known as the Ankle/Brachial Index or ABI) compares the systolic blood pressure of the ankle to that of the arm (brachial).

Normally, the blood pressures in your ankle and arm should be about equal. But if your ankle pressure is half your arm pressure (or lower), your leg arteries are probably narrowed.

These measurements are useful in the assessment, follow-up and treatment of patients with peripheral vascular disease (PVD). ABI's provide an objective baseline to follow the progression of the disease process and evaluate the effectiveness of the treatment plan.

To perform the ABI, your physician will use an ordinary blood pressure cuff and an ultrasound device. The ABI results are usually combined with Doppler or pulse volume waveform analysis.

Pulse volume recording demonstrating bilateral segmental pressure decrease across the superficial femoral arteries, significantly worse on the left side than on the right side. Note the mild dampening of the arterial wave form on the left, compared with the right. The ABI is consistent with mild disease on the right and moderate to severe disease on the left. Note the significant decrease following exercise. The resting ABI is calculated as 171/191 = 0.90 (right) and 112/191 = 0.59 (left). All calculations are based on the higher brachial systolic reading, which in this case is 191. The ankle systolic reading is based on the higher of the posterior tibial and dorsalis pedis systolic readings. (ABI = ankle-brachial index; PT = posterior tibial; DP = dorsalis pedis)

Treatment for PVD may include

• Lifestyle Modifications to Control Risk Factors - including regular exercise, proper nutrition, and smoking cessation
• Aggressive Treatment of Existing Conditions that may Aggravate PVD - such as diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol)
• Medications for Improving Blood Flow - such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls
• Angioplasty - a catheter (long hollow tube) is used to create a larger opening in an artery to increase blood flow. Angioplasty may be performed in many of the arteries in the body. There are several types of angioplasty procedures, including: balloon angioplasty, atherectomy, laser angioplasty and stents.
• Vascular Surgery - a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow.

To schedule an appointment with a Cooper University Hospital physician at an office near you, call 1-800-8-COOPER (800-826-6737) to speak with a member of our physician referral and information service.

Our Offices

Camden
Three Cooper Plaza, Suite 403
Camden, New Jersey 08103
Appointments (856) 342-3113
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Marlton
127 Church Road, Suite 400
Marlton, New Jersey 08053
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Voorhees
6017 Main Street
Voorhees, New Jersey 08043
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Washington Township
Bunker Hill Plaza, Suite 202
Sewell, New Jersey 08080
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Our Physicians

• Babak Abai, M.D.
• James B. Alexander, M.D.
• Jeffrey P. Carpenter, M.D.
• Joseph V. Lombardi, M.D.