Peripheral Vascular Disease and Arterial Ulcers

Peripheral Vascular Disease (PVD) is more commonly referred to as poor circulation, and occurs due to the narrowing of the arteries that supply blood to various parts of the body. Narrowing of the arteries (stenosis) is caused by atherosclerosis, the build-up of fatty deposits (plaque) on the inside walls of the arteries.

When the arteries that carry blood to the legs become narrower, blood flow is reduced and the muscles do not receive an adequate amount of oxygen to support physical activity, causing cramping pain known as intermittent claudication. PVD often affects the arteries that supply blood to the legs, leading to a circulation disorder in the lower limbs. If left untreated, PVD can seriously impair quality of life and can cause arterial ulcers (commonly found in the feet and lower legs) and gangrene (tissue loss) due to a critically inadequate supply of blood.

For a detailed guide to recognising, investigating and treating arterial ulcers, including clinical photographs and referral advice for GPs, see our dedicated Arterial Ulcers page.

Risk Factors

Major risk factors for the development and progression of PVD include smoking (5 to 7 times increased risk), diabetes (5 times increased risk), high blood pressure, high cholesterol, increasing age and family history.

Diagnostic Techniques

Investigations used to assess PVD include physical examination, blood pressure measurements in the legs (ankle brachial pressure index and toe pressure assessment), Doppler ultrasound (duplex) imaging, CT angiography (CTA), magnetic resonance angiography (MRA) and diagnostic angiography.

Treatment Options

Lifestyle changes include stopping smoking, taking regular exercise, improving diet and caring for the feet.

Medication may include drugs to prevent blood clots, control high blood pressure and lower cholesterol.

Angioplasty involves gaining access to the femoral artery in the groin and guiding a thin catheter through the blood vessels to the location of the plaque, where a small balloon is inflated to flatten the plaque and remove the obstruction.

Angioplasty and stenting involves placing a stent after balloon angioplasty to hold the artery open where angioplasty alone is insufficient.

Atherectomy enables the removal of excessive plaque from the artery using a highly sophisticated mechanical device inserted in the same way as an angioplasty balloon, and can reduce the need for arterial stents.

Endarterectomy and patch angioplasty is an open surgical procedure that removes atherosclerotic plaque from the artery, usually treating short arterial segments at important bifurcations such as the common femoral artery.

Open bypass surgery creates a communication between arteries above and beyond the narrowing or blockage using either native vein or synthetic prosthetic material.

Drug eluting balloon angioplasty and drug eluting stents deliver antiproliferative medication directly to the vessel wall to reduce the risk of restenosis and improve long-term outcomes.