By Asma Khan, DPM
February 02, 2013
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Peripheral Vascular Disease (PVD) Part II

Diagnostic Tests and Treatments

The exam for PVD begins with an evaluation of the appearance of the lower legs and feet.  Thin, shiny skin that is hairless is highly suspicious for poor circulation.  Discolorations of the skin are also common.  Ulcerations are a harbinger for advanced disease.  Your doctor may also feel for the pulses in your feet, specifically the dorsalis pedis pulse on the top of the feet and the posterior tibial pulse on the inside aspect of the ankles.  If these are not readily felt, a hand-held Doppler may be utilized to locate and hear the pulses.  If enough suspicion exists for the presence of underlying PVD, your doctor may order non-invasive blood flow studies, such as the ankle-brachial index, arterial waveforms, and toe pressures.

The ankle-brachial index (ABI) compares the blood pressure in the arms with the blood pressure at the ankles.  An ABI above 0.90 is normal; 0.70-0.90 indicates mild peripheral vascular disease; 0.50-0.70 indicates moderate disease; and less than 0.50 indicates severe peripheral vascular disease.  The arterial waveforms should be triphasic and toe pressures greater than 30 mmHg are considered sufficient for healing.

Any abnormal preliminary findings necessitate further workup and evaluation by a vascular specialist.  The vascular physician will determine if you are a candidate for computed tomography (CT) angiography or magnetic resonance (MR) angiography.  These studies are utilized to visualize the arterial network of blood flow from the aortic branches all the way to the digits.  If defects in blood flow are found, an intervention can be performed at the same time, or be scheduled at a later date.

Angioplasty

This procedure can be performed by making small incisions and passing a wire into arteries at the site where narrowing is identified.  A small balloon is inflated at the site to widen the narrowed space.  A stent may be placed to maintain the opening.  Depending on the specific circumstances, your vascular physician may perform this as an in-patient procedure with an overnight stay at the hospital for observation.

Bypass

If balloon angioplasty and stenting does not provide sufficient blood flow to the lower legs and feet, or the artery shuts down again, a bypass graft may become necessary.

This procedure requires larger incisions.  A viable vein is harvested and used as the bypass vessel.  The area of the artery that is blocked is then tied off, and the vein is restructured to the artery in its place to provide unobstructed blood flow.

Non-surgical treatments

Several medications are utilized, both independently and with surgery, to alleviate symptoms of PVD.  Aspirin and other anti-platelet medications are used to improve blood flow and reduce the chances of clotting.  Statins are a group of medications that help reduce cholesterol and cholesterol build-up.  Using blood pressure medications as your doctor prescribes is important to prevent constriction of the arteries.  If you are diabetic, maintaining good glucose control is one of the most important things you can do to improve the health and function of your arteries.

  

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