DIABETIC WITH PERIPHERAL VASCULAR DISEASE

The term peripheral vascular disease refers to any obstruction of large arteries in the limbs, most commonly in the legs and feet. The condition is also known as peripheral artery disease and the two terms are often used interchangeably. Peripheral vascular disease can cause pain, weakness, numbness, and changes in color of the affected limb. Peripheral vascular disease eventually causes narrowing and hardening of the arteries that carry blood to the feet, and the decrease in blood flow can cause injury to the nerves. It’s estimated to affect 12 percent of the general population and up to 20 percent or more of Americans over the age of 70. Most sufferers are men, although woman can become more susceptible during and after menopause.

Some cases of peripheral vascular disease are mild, and in about 20 percent of cases there are no symptoms at all. In more severe cases, however, patients may experience:

1. Claudication—pain in the legs that occurs with walking and impairs mobility
2. Weakness
3. Numbness
4. Tingling sensation in the feet and toes
5. Change in color (the limb or digits may appear pale or even blue)
6. Chronic discomfort in the thigh or calf muscles
7. Impotence
8. Varicose veins
9. Hair loss on the legs and feet
10. Sores or wounds that heal very slowly or do not heal at all

In the early stages of peripheral vascular disease, sufferers may find that vigorous exercise has begun to seem more difficult. As the disease progresses, even mild exercise tends to aggravate the symptoms, and eventually those symptoms even present themselves when the sufferer is at rest.

Causes of Peripheral Vascular Disease
The most common cause of PVD is arteriosclerosis. This is a buildup of plaque on the walls of the arteries, which stiffens them and narrows the space through which blood needs to flow. The problem is exacerbated by the stiffening of the artery walls, which prevents the arteries from dilating to allow more blood flow. In some cases blood clots may also form in the arteries, further inhibiting blood flow. While arteriosclerosis is the most common cause of peripheral artery disease, the condition can also be caused by trauma or infection. Patients who suffer from coronary artery disease also tend to suffer from peripheral artery disease.

Categories and Stages of Peripheral Vascular Disease
There are two categories of PVD—functional and occlusive. Occlusive PVD involves blockage of the artery (usually by plaque). In cases of functional PVD, the artery spasms and constricts. Reynaud’s Phenomenon, a condition that makes sufferers unusually sensitive to cold, especially in their extremities, is thought to be a type of functional peripheral vascular disease. Reynaud’s Phenomenon causes many of the same symptoms as other forms of peripheral vascular disease, and sufferers may also experience brittle nails.

In 1954 the progress of peripheral vascular disease was divided into four stages by René Fontaine; these stages are now called the Fontaine Stages:

1. Stage I: The arterial obstruction is not yet significant, and the subject is not experiencing symptoms
2. Stage II: Mild pain when walking
3. Stage III: Pain is present even when the subject is at rest
4. Stage IV: Gangrene begins to set in

Risk Factors for Peripheral Vascular Disease

Peripheral artery disease is most common among men over the age of 50, especially those who are heavy smokers. Anyone who has ever had a stroke is also at elevated risk. Additional risk factors include:

1. High Cholesterol
2. High blood pressure
3. Diabetes
4. Heart or kidney disease

When to Seek Medical Attention
Never let anyone tell you that pain and numbness in your legs is just a normal part of the aging process. It is not normal; it is a potentially serious medical condition that requires treatment. If peripheral vascular disease is left untreated it will progress, and there is even the possibility—however small—that you might lose a foot, or even a leg. Contact your healthcare provider immediately if you have leg pain while walking, or if you have numbness or tingling in your limbs.
Even if you are not experiencing any of the symptoms of PVD, you should be screened for it periodically if you are over the age of 70, or if you are over the age of 50 and have risk factors such as diabetes, obesity, or tobacco use.

Complications of untreated peripheral vascular disease can include:

1. Blood clots
2. Coronary artery disease
3. Heart attack
4. Stroke
5. Deep vein thrombosis (a blood clot in a vein travels to the lungs and blocks a vein, causing a life-threatening pulmonary embolism)
6. Gangrene, possibly requiring amputation (this usually appears first in the form of sores that do not heal)
7. Ulcerations or non-healing wounds of the feet or legs

Prevention and Treatment of Peripheral Vascular Disease
While peripheral vascular disease is very common, there are many lifestyle choices that can help to prevent it, or at least to reduce your risk. Tobacco cessation is the first and simplest of these choices. If you have diabetes or hypertension, work with your primary care doctor to keep it under control. Watch your diet, and ask your doctor for his or her advice on controlling your cholesterol intake. Lastly, it is important to exercise regularly; if you can manage 30 minutes of vigorous exercise daily, you should do so. At the very least, make a habit of going for a 20-minute walk each day, if you can.

Treatment of peripheral vascular disease may involve surgery such as angioplasty (surgical widening of obstructed or narrowed arteries) or plaque excision, in which the plaque that is blocking the artery is scraped away.

Your doctor may attempt to treat your peripheral vascular disease with medications rather than surgery (or in addition to it). A variety of medications are available for the control of blood sugar, cholesterol, high blood pressure, and blood clots, and Foot and Ankle Surgeon may want to try a medication-oriented approach before resorting to surgery.