Risk factors and treatment for peripheral vascular disease

Peripheral vascular disease affects around one in five people aged over 60 in the UK. It causes narrowing of blood vessels (arteries) due to the build-up of fatty deposits inside the wall of the arteries in a process called atherosclerosis. Symptoms are most often experienced in the legs due to reduced blood reaching the leg muscles. Peripheral vascular disease usually develops gradually but if left untreated can eventually lead to the blood supply being affected to such an extent that loss of your leg becomes a risk. 

Risk factors for peripheral vascular disease

One of the biggest risk factors for peripheral vascular disease is smoking. The toxins released into your body from smoking damage the lining of your blood vessels, including the arteries that supply your legs. Diabetes, high blood pressure and high cholesterol also increase your risk of peripheral vascular disease.

In the absence of these risk factors, you can still develop the disease due to ageing. It is, therefore, important to be aware of the symptoms of peripheral vascular disease so you can seek treatment. 

Peripheral vascular disease symptoms

The most common symptom is a cramping pain in your calves when walking, which disappears when you stop walking. This is known medically as intermittent claudication, which describes muscle pain on activity that stops at rest.

Initially, the calf pain occurs only when you’ve been walking for some distance. When walking long distances, your muscles work harder and need a greater blood supply, which your body can’t deliver due to the narrowed arteries supplying your legs. However, as the disease progresses, pain can occur after shorter and shorter distances as the blood supply to your legs is further restricted by narrower arteries. In most cases, people seek advice at this point and are investigated for peripheral vascular disease.

In more severe cases of peripheral vascular disease, you can develop leg pain even at rest and may also develop ulcers on your feet. This is known as critical limb ischaemia, which needs to be urgently treated to prevent limb loss. Critical limb ischaemia can be a result of a progressive narrowing of the arteries but is much more frequently caused by a sudden blockage of the arteries, most often caused by a thrombus (clot).

Non-surgical treatments for peripheral vascular disease

Treating peripheral vascular disease focuses on improving your symptoms and preventing other problems related to blood vessel disease. This is because if you have peripheral vascular disease, you are much more likely to have problems with other blood vessels, such as those supplying your heart and brain. Being affected by peripheral vascular disease, therefore, increases your risk of stroke and heart attacks. Consequently, a significant part of any treatment plan for peripheral vascular disease focuses on reducing your risk of stroke and heart attacks.  

Treating leg pain caused by peripheral vascular disease involves managing the risk factors for vascular disease, notably quitting smoking, as well as managing high blood pressure, high cholesterol and diabetes, if you have any of these health problems. The drugs clopidogrel or aspirin are used to help prevent blood vessels becoming blocked and the group of drugs called statins are used to control cholesterol levels; statins also have a protective effect on blood vessels. The use of these medications can improve leg symptoms and also reduce the risk of stroke and heart attacks.

Finally, exercise is of great value, ideally as part of a supervised exercise programme to gradually increase your walking distance. You may not reach the point of being able to walk long distances without any pain, however, the aim is to increase how far you can comfortably walk and therefore improve your quality of life, as well as enabling you to maintain a level of fitness.

This approach to treating peripheral vascular disease — making lifestyle changes, taking appropriate medication and exercising regularly — is the most effective way to manage the disease and importantly reduce your risk of other potentially life-threatening conditions, namely stroke and heart attacks.

When is surgery needed for peripheral vascular disease?

Surgery in peripheral vascular disease is usually only undertaken when people are affected by quite significant symptoms. This is because surgery of blood vessels can be quite risky, with the possibility of making things worse.

Your surgeon will discuss all the risks and benefits of surgery for peripheral vascular disease with you, so you can make an informed decision. If, after consultation with your surgeon, it is decided that the benefits of surgery outweigh the risks in your case, then surgery may be an option.

Surgery on blood vessels is either endovascular surgery using techniques inside your artery to open it up (angioplasty and stenting) or more traditional open surgery where cuts and bypasses are used to improve blood supply to the leg.

Advances in peripheral vascular disease surgery

Angioplasty techniques, where wires and balloons are used to open the blood vessels, are being developed all the time. Increasingly, combinations of techniques are being used, which include traditional angioplasty and stenting as well as using devices that contain drugs which help prevent recurrence of the narrowings.

Other techniques being used are atherectomy, where the calcium in the vessel wall is mechanically removed, and lithotripsy, where sound waves are used to break the calcium in the vessel wall. Endovascular surgeons are continually gaining experience of which of these techniques, and in what combination, is best for each type of blood vessel problem.

As these advances in surgical techniques continue and the risks come down, surgery may become suitable in more cases. However, it still holds true that non-surgical treatment of mild to moderate peripheral vascular disease is usually preferable to any kind of surgery.

Author biography 

Mr Gary Maytham is a Consultant Vascular Surgeon at Spire Gatwick Park Hospital and at St George's and East Surrey NHS Hospitals, specialising in the management of peripheral vascular disease, aneurysmal and carotid disease, varicose vein treatment and vascular and torso trauma. Mr Maytham is also Unit Lead for the treatment of venous disease at St George's Vascular Institute and Clinical Lead for Vascular Trauma at the Major Trauma Centre.