Peripheral vascular disease (PVD)

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Peripheral vascular disease (PVD) is an umbrella term for any blood circulation disorder that affects blood vessels outside of your heart, including both arteries and veins. It can involve narrowing, blockage or spasm in any of the peripheral blood vessels, restricting blood flow. 

PVD can affect the blood vessels that supply blood to the legs and arms, as well as vital organs such as the stomach, kidneys, intestines and brain. When it restricts the blood flow to these parts of the body, they don't get enough oxygen and lose their ability to function properly.

Peripheral vascular disease vs peripheral artery disease

Peripheral artery disease (PAD) is often used interchangeably with peripheral vascular disease but they're distinct conditions.

Peripheral artery disease is a type of PVD, encompassing blood circulation disorders that affect the arteries supplying blood to the limbs. Peripheral vascular disease includes both the conditions affecting arteries described by PAD, as well as conditions affecting veins. Arteries take blood to the extremities, while veins carry it away from the extremities and back to the heart and lungs.

PVD has various causes, the most common of which include:

• Atherosclerosis, plaque build-up inside the walls of the blood vessels
• Arterial and deep vein thrombosis, which is when blood clots form inside the blood vessels
• Diabetes, which causes a high blood sugar level that can damage, narrow and weaken blood vessels over time
• Vasculitis, a group of conditions causing inflammation of the blood vessels
• Other causes of peripheral vascular disease include:
• Injury to the arms or legs
• Irregular anatomy of muscles or ligaments
• Infection
• Structural defects in the structure of the blood vessels, typically acquired at birth

Who's at risk of developing peripheral vascular disease?

There are numerous risk factors for PVD. You have a higher risk of developing it if you are:

• Over the age of 50
• Overweight
• Male

You're also at higher risk of developing peripheral vascular disease if you or members of your family have one of the following conditions:

• Coronary artery disease
• Diabetes
• High cholesterol
• Heart disease
• High blood pressure

Lifestyle choices that increase your risk of developing PVD include:

• Not engaging in regular exercise
• Not eating a healthy diet
• Smoking or using drugs

Complications of peripheral vascular disease

If left untreated, PVD can lead to several complications, some of which are life-threatening. These include:

• Poor wound healing: One of the most common complications is difficulty healing wounds, especially on the legs and feet. With insufficient blood flow, the body struggles to build new tissue and fight off infection, leading to chronic ulcers that are slow to close or don't heal at all.
• Erectile dysfunction: In men, PVD can restrict blood flow to the penis, leading to difficulty achieving or maintaining an erection (erectile dysfunction).
• Deep vein thrombosis: This is when a blood clot develops in a large vein in your leg, usually the calf or thigh.
• Critical limb ischemia (CLI): This serious complication arises when blood flow to a limb is severely restricted. It causes intense, persistent pain, even at rest, often described as burning or cramping. The skin may become pale, shiny, and cold, with sores that won't heal and possible gangrene (tissue death).
• Gangrene: In the most severe cases, tissue death (gangrene) can occur due to a lack of blood flow deprives tissues of oxygen and nutrients for an extended period. Gangrene can affect toes, feet, or even larger portions of the leg and may require amputation to prevent the spread of infection.

How is peripheral vascular disease diagnosed?

At your cardiovascular appointment, your consultant will listen to you describe your symptoms, take a complete medical history and conduct a physical examination. They will then recommend some diagnostic tests to help determine the cause of your symptoms.

Tests that can help make a peripheral vascular disease diagnosis include but aren't limited to the following:

• Angiogram: This is an X-ray of the blood vessels to detect narrowing or blockage. It involves inserting a thin and flexible tube into a leg artery and injecting a contrast dye to make the blood vessels visible on the X-ray imaging. It’s typically used if surgery is being considered.
• Ankle-brachial index (ABI): An ABI compares the blood pressure in the ankle with the blood pressure in the arm, using a blood pressure cuff and a Doppler ultrasound device. The pressure should normally be higher in the legs than in the arms but it could indicate PVD if it's significantly higher.
• Doppler ultrasound scan: High-frequency sound waves create images of your blood vessels on a computer, allowing your consultant to assess blood flow.
• Magnetic resonance angiogram (MRA): Instead of X-rays, an MRA uses magnetic resonance imaging (MRI) to take images of your internal structures, giving accurate and detailed images of your blood vessels. As with an X-ray angiogram, a special dye is injected into your bloodstream to help make the blood vessels visible.
• Treadmill exercise test: You walk on a treadmill or perform some other form of exercise, while your consultant monitors your blood circulation. A significant drop in leg blood pressure and ABI after exercise suggests peripheral vascular disease.
• Photoplethysmography (PPG): This test uses light to measure blood flow changes in the skin, often used along with other tests.

Your consultant will only recommend the tests they think will be most effective for arriving at a diagnosis. They'll explain exactly what's involved and answer all your questions, making sure you have peace of mind before you decide whether to go ahead.

Lifestyle changes for the management of peripheral vascular disease

Your consultant will recommend lifestyle changes that address your risk factors, in conjunction with treatment options. This could include:

• Avoiding or quitting smoking
• Eating a nutritious diet that avoids foods high in fat or cholesterol
• Maintaining a healthy weight
• Engaging in moderately strenuous exercise on a regular basis

Peripheral vascular disease (PVD) treatment options

The most effective treatment depends on the underlying causes of your PVD. Your consultant will recommend the most effective medications or treatments for the management of your peripheral vascular disease.

Medications for peripheral vascular disease

The underlying cause of your peripheral vascular disease determines what medications will be effective for treatment. Because of this, your consultant might recommend a wide variety of medications, including but not limited to:

• Angiotensin-converting enzyme (ACE) inhibitors, to lower high blood pressure
• Antiplatelet medicines like aspirin, clopidogrel or ticlopidine to reduce blood clotting
• Cilostazol or pentoxifylline, to improve blood flow and reduce leg pain caused by poor circulation
• Cholesterol-lowering medicines like atorvastatin, simvastatin or other statins
• Diabetes medication, to control blood sugar levels if you have diabetes

Medical procedures for the management of peripheral vascular disease

Medication alone is often an effective treatment for minor cases of peripheral vascular disease, yet more significant blockages may require a medical procedure for management. The most common procedures for peripheral vascular disease are:

• Angioplasty: This is a non-surgical procedure that widens narrow or blocked arteries using a balloon. A needle is used to insert a catheter (thin tube) with a tiny balloon attached to the end. The balloon is inflated inside the artery, pushing aside plaque and widening the artery so blood flow is no longer restricted. The balloon is then deflated and removed.
• Stenting: In some cases, an angioplasty is performed and then a stent (small wire mesh tube) is fixed inside the widened artery and remains to hold it open. This procedure isn’t typically the first course of action.

Paying for private PVD treatment

You have two main payment options for your private peripheral vascular disease tests and treatment: paying through private medical insurance or paying for yourself. If you want to be seen by the #1 provider for vascular care, mention HCA UK and your preferred consultant when discussing treatment with your insurer. If you choose self-pay, we'll provide you with a clear and transparent quote upfront, so you know exactly what to expect.