Legs for Life: Peripheral Vascular Disease

Date:
9/10/2009 | 12:00 pm

Peripheral vascular disease (PVD) is a very common circulation condition affecting 12-20 percent of Americans age 65 years and older. If undiagnosed and untreated it can significantly affect your quality of life and long-term health.

PVD develops most commonly as a result of atherosclerosis or “hardening of the arteries,” which occurs over time when cholesterol and scar tissue build up forms plaque that narrows and clogs the arteries. This results in decreased blood flow that can often result in pain, cramping or tiredness in the legs while walking or climbing stairs.  Typically, this pain goes away with rest and returns when you walk again. Many people with PVD have no symptoms or mistake their symptoms for a normal part of aging. If you have PVD, you are at high risk for heart disease and stroke.

Clinical Cardiologist Elias A. Iliadis, M.D., will answer your questions about diagnosis and treatment for PVD, and heart disease. Dr. Iliadis is Medical Director of Noninvasive Vascular Intervention, Cooper Heart Institute; Director of the Cardiac Catheterization Laboratory at Memorial Hospital of Salem County; and Assistant Professor of Medicine, UMDNJ-RWJMS at Camden. He is board certified in Internal Medicine in three and two cardiology specialties Cardiovascular Disease, and Interventional Cardiology and Internal Medicine. Dr. Iliadis graduated from UMDNJ - Robert Wood Johnson Medical School and completed an internship and residency at Thomas Jefferson University Hospital in Philadelphia, Pa. He completed his fellowship training in cardiology was a Fellow at the University of Michigan Medical Center.

Dr. Iliadis’ special interests include: coronary artery disease and intervention, heart attack care, peripheral vascular disease and intervention, nuclear cardiology and noninvasive vascular disease assessment. He sees patients in his office in Voorhees.

I have these symptoms, but I'm only 50. Could this be PVD, or more likely something else going on? Kathleen from Camden

9/10/2009 12:02:58 PM

Elias A. Iliadis, M.D.: Kathleen, a very common question is whether leg pains are peripheral vascular disease or arthritis or something else. Making the diagnosis of PVD requires a physician's exam and simple, non-invasive tests such as ankle-brachial index and arterial dupluex exams. All PVD patients are treated with medical therapy as a start and most feel better.  Your family physician can examine you or suggest a vascular lab as the next step. I hope this helps.

I occasionally get cramps on my legs while sleeping on cold nights. For the past week, my right foot hurts while walking or standing from the middle of my foot to the area before the toes. I got fascitis that was relieved with steroids a few months ago. Is this new pain arthritic or PVD? Josephine from Cherry Hill

9/10/2009 12:04:54 PM

Elias A. Iliadis, M.D.: Josephine,

While PVD can cause foot pain, it is usually not so localized. PVD typically causes  leg pain with walking, relieved with rest, while fascitis can cause night-time pain as well as localized pain such as yours. I would recommend that you see your podiatrist or sports medicine specialist which might help. Good luck and be well.

I have atherosclerosis and sometimes my ankles swell. Is this a symptom of PVD? What should I do when this symptom occurs? Thank you. Jeri from Galloway

9/10/2009 12:07:55 PM

Elias A. Iliadis, M.D.: Jeri,

Patients with PVD can experience swelling. A  pulse examination by your MD and non-invasive testing would help determine the cause and severity of blockage (AKA atherosclerosis) and its contribution to your swelling. If no blockage is found, other causes should be evaluated such as cardiac and venous. The non-invasive lab can help assess these causes as well.

What are the symptoms of PVD? I walk almost every day for 3 miles. I experience no pain before, during, or after my walk. However, I noticed lately that my veins on my feet and my lower legs get really pronounced. I follow my walk with yoga and arm exercises with weights. This is when I really notice my veins. Thank you. Susanne from Pilesgrove

9/10/2009 12:10:34 PM

Elias A. Iliadis, M.D.: Susanne,

What you described sounds more like venous prominence than actual arterial vascular disease.  PVD causes symptoms when walking while venous disease or incompetence would cause swelling or discoloration with walking.  An assessment of the venous system with upright venous study would help identify venous incompetence and usually treatment is conservative.

First, thank you for your time and attention to my question. I am a young woman (49 yrs.) and have been diagnosed with "mild" reflux both saphenous veins in my legs. I have compression stockings which have not helped. I work long shifts in a restaurant on hard floors with no formal breaks. Am I severely further worsening my condition by continuing this job? Is the surgery ( laser ablation of both veins ) a definite cure, or will I continue to develop other varicosities as I age? My legs are overly heavy, achy and uncomfortable. A mere 3 years ago I was an avid high mountain climber; will I be able to resume this hobby safely after saphenous vein ablation? Thank you again for your much appreciated comments. Maria from Paterson

9/10/2009 12:12:38 PM

Elias A. Iliadis, M.D.: Maria,
A common problem among women is venous incompetence.  The risk of developing this condition is gender (yes, just being female), tobacco smoking, if you take oral contraception, multiple pregnancies, as well as what your occupation is (if you stand a lot).  With support hose, you can minimize the progression of the incompetence, but not reverse it.  Laser ablation, which our surgeons at Cooper perform, also closes the superficial veins and controls incompetence but relapses do occur so monitoring is key.  Further evaluation of your legs with both venous and reflux studies might further help identify problem spots.

My husband is an adult on-set insulin dependent diabetic who smokes. In the last year his legs and ankles are swelling, it is slightly reduced by elevating his legs. I am extremely concerned by this, however his family practitioner tells him he is not concerned. Should he see a cardiologist? Husband's father had quadruple bypass surgery in his early sixties. Pat from Palmyra

9/10/2009 12:16:00 PM

Elias A. Iliadis, M.D.: Pat,

Thank you for your question. Your husband sounds like he's at high risk for the development of PVD since he is diabetic and smokes (two of the highest risk factors for PVD).  Swelling can occur from a vascular cause and, more commonly, from a cardiac cause. Swelling for PVD is one of the late finding usually preceded by pain or poor wound swelling.  I agree with your plan to see a cardiologist who would be able to tease out whether there is a cardiac or vascular problem through non-invasive testing of the legs and heart.  Good Luck.

My 83 year old father has been diagnosed with PVD and is hestitant to have any type of invasive procedure to fix this issue. He has had one mild heart attack (26 yrs ago) and underwent a double bi-pass around 15 years ago. He takes meds for BP and cholestrol control. Is there any non or minimally invasive treatment available to him? Kathy from Southampton

9/10/2009 12:18:14 PM

Elias A. Iliadis, M.D.: Great question. Commonly, patients with coronary artery disease have PVD. The vascular specialist usually defines the severity of disease and starts with medical therapy. The vast majority of patients improve their symptoms but need careful monitoring. We use minimally invasive (endovascular) techniques frequently and especially for those who don't improve on medical therapy or have advanaced disease.  Be well and good luck.

Is venous stasis the same as PVD? Can venous stasis be cured? I have an ulcer on my right leg and venous stasis. Mary from Pennsauken

9/10/2009 12:20:49 PM

Elias A. Iliadis, M.D.: Usually PVD is meant to imply arterial blockage while the venous system is not a blockage issue but an incompetence of the veins issue. This causes backflow of blood which usually pools in the lower legs and feet.  This causes discoloration and swelling.  A vascular specialist and non-invasive lab can help ensure lack of blockage and define the venous problem. 

Once ulcers start, you have significant pressure on the legs and are difficult but not impossible to treat.  A vascular specialist may be able to help you.

Hope this helps clarify issues.

How can you really tell what is causing the pain that I feel? It primarily starts just below the knee cap in front of my right leg, (never my left leg) and it starts just below the knee and extends downward about halfway down the front of my leg. Is this shin splints or PVD or what else could it be? The pain can be excruciating at time. Burt from Atco

9/10/2009 12:22:50 PM

Elias A. Iliadis, M.D.: It's sometimes difficult to differentiate between vascular, arthritis, and restless leg syndrome. As vascular specialists, we perform a simple test (ankle brachial index or pulse volume recordings) to help define the contribution of vascular disease to symptoms. If testing is normal, other causes may exist.

I have a wound, ulcerated, that will not heal due to venous stasis. Is there any way to get this to heal? I have tried everything that the doctors have told me to do for the last 7 months. Mary from Pennsauken

9/10/2009 12:24:01 PM

Elias A. Iliadis, M.D.: If testing has identified venous stasis and incompetence as your problem, a consultation with a specialist who treats venous problems as well as a wound specialist may help.

I had "closure procedure" on my left leg 2 years ago. The vein treated still looks blue and bulges after working out. Doctor says veins would need to be striped to eliminate and considered cosmetic. If vein was closed why is it blue? I thought the body would absorb a vein once closed. I'm not satisfied with the outcome. Your feedback appreciated. Thank you. Lynn from Cherry Hill

9/10/2009 12:26:33 PM

Elias A. Iliadis, M.D.: Venous closure is only the start to one's varicose treatment. The veins are sclerosed but not removed and therefore can be seen at times. Follow-up venous ultrasounds are performed to ensure the veins are scarred. You will want to have an ultrasound of your veins, as over time, more channels appear that might need treatment. Good Luck.

What is the treatment for PVD? How is it diagnosed? Linda from Cherry Hill

9/10/2009 12:29:31 PM

Elias A. Iliadis, M.D.: We begin by evaluating your risk factors, performing a physical examination and if necessary, obtain non-invasive vascular testing.  I begin treatment with medical therapy on all patients and evaluate the benefits of angiography and or stenting on a case-by-case basis. Most patients have relief of symptoms on medical therapy and we reserve stenting and or surgery for those who continue to have symptoms.

Patients should receive a history and physical exam from a vascular specialist such as myself as well as assessment of risk factors such as diabetes, hypertension, lipids and tobacco use as well as exotic risk factors such as LPA and Homocysteine which can accelerate atherosclerosis.  Lastly, a non-invasive test will help identify severity of the disease and follow up as needed.

Is PVD the same as varicose veins, or are they related in any way? Todd from Decatur

9/10/2009 12:31:09 PM

Elias A. Iliadis, M.D.: That is a common question. PVD usually deals with arterial disease while venous disease has different risk factors and takes a different course.  PVD is caused by risk factors that cause atherosclerosis (diabetes, hypertension, lipids, tobacco and family history) while venous disease is caused by tobacco, female gender, OCP, family history of venous problem and other exotic causes mentioned above. 

Venous problems are usually chronic and are treated conservatively at first, with support hose and later with ablation therapy.  PVD treatment usually addresses the risk factors, evaluation of disease by non-invasive testing and selective use of stenting and surgery.  Most PVD patients are well managed on medical therapy. Hope this helps your understanding.

In March 2008 I had a right orbitozygomatic craniotomy. I'm still experiencing (difficult to explain) what feels like numbness, like I just had a Novacain, tingling, sensitive to cold etc. What can I do to help repair the nerves and muscle? Please guide me for a quicker recovery for my poor face. :) Thank you. Luisa from Palmyra

9/10/2009 12:32:38 PM

Elias A. Iliadis, M.D.: Thank you for your question.  However, while your symptoms may resemble signs of a stroke AKA cerebralvascular disease, given you recent surgery, I would suggest that the cause is related to your surgery and you should contact you surgeon.  Please feel free to contact us with any further questions.

Hi Dr. Iliadis. I have varicose veins, but one in particular is very long and protruded going up the length of my upper and lower leg. It, however, does not bother me at all. Will I, nevertheless, have to do something about it one day, or is it OK to just leave it alone? Lois from Camden County

9/10/2009 12:34:54 PM

Elias A. Iliadis, M.D.: Varicose veins are difficult to treat as they tend to recur and progress. The risk factors for developing venous disease have been addressed in answers above. Treatment is usually conservative at first with support hose and monitoring for the veins with ultrasound. They usually do progress and may cause swelling and, lastly,  venous ulcers which are very difficult to treat. As with all diseases, it is better to obtain treatment and evaluation sooner and begin treatments. Good Luck

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