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Medical Services
Evaluation and Diagnosis
A thorough medical history and physical exam, along with an assessment of risk factors will be performed. Several diagnostic tests are available to confirm the presence of PVD and determine the appropriate course of treatment. Most of these tests are noninvasive and painless.
- Pulse Volume Recordings (PVR)
A PVR study is a noninvasive vascular test in which blood pressure cuffs and Doppler are used to get information about arterial blood flow in the arms and the legs. This information is then used to determine the presence, severity and general location of peripheral vascular disease.
- Ankle-brachial index (ABI)
ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device. To determine ABI, the systolic blood pressure (the top number of the measurement) of the ankle is divided by the systolic blood pressure of the arm.
- Single-level ABI
Cuffs are placed on the upper arms and at the ankles while a Doppler (probe) is placed on the pulse at the feet to hear the sound of the artery. A loud, rhythmic whooshing sound corresponds with every heartbeat. As the cuffs are inflated, the sound disappears and slowly returns as the cuff is deflated. This provides a baseline reading.
- Multi-level ABI (also called segmental ABI)
In addition to the arms and ankles, cuffs are placed on each calf, above the knees and at the thighs. This reading will help pinpoint where in the arteries the blockages occur.
- Stress ABI
Used for patients complaining of intermittent claudication. After the multi-level ABI is performed, the patient is placed on a treadmill for 5 minutes, or until they are unable to continue walking. Pressures are recorded as soon as possible after ending the exercise.
Before testing
- Do not bring valuables, such as jewelry and credit cards.
- Do not smoke or participate in strenuous activities for 24 hours before the test.
- You may take your usual medications.
- There are no special dietary guidelines; you may eat and drink as you normally would.
- Wear comfortable clothing. Ladies should wear slacks or shorts.
During testing
- Your vascular test is performed by specially trained technologists and interpreted by a vascular medicine physician.
- You will lie on a PVDded examining table during the test. You may walk on a treadmill for part of the test, based on the type of test that has been ordered.
- Several blood pressure cuffs are placed on various parts of your arms and legs, depending on the area being examined.
- A small amount of water-soluble gel is applied to the skin over the area to be examined. The gel will not harm your skin or stain your clothes.
- The blood pressure cuffs are inflated while a small device called a transducer or Doppler is held in place on the skin's surface until the blood flow information has been recorded. You may experience mild discomfort while the blood pressure cuffs are inflated.
- The Doppler transmits sound waves through the tissues of the area being examined. These sound waves reflect off blood cells moving within the blood vessels, allowing the physician to calculate their speed. The sound waves are recorded and displayed on a computer screen.
After testing
- You will be discharged home without restrictions
- You will be given the results on your follow-up appointment
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Treatment Options
There are several treatments available for patients with PVD, from medications to surgery. In addition, new technology is available to treat patients using nonsurgical methods, many of which can be performed on an outpatient basis, such as stents and the removal of blockages. Your physician will determine which one is right for you.
- Medications
Your doctor may recommend certain medications to treat high blood pressure (anti-hypertensive medications) or high cholesterol. An antiplatelet medication, such as aspirin or clopidogrel (Plavix), may be prescribed to reduce the risk of heart attack and stroke. Cilostazol (Pletal) may be prescribed to improve walking distance. This medication has been shown to help people with intermittent claudication exercise longer before they develop leg pain and to walk longer before they must stop because of the pain. Your doctor will determine which medications are right for you.
- Interventions
More advanced PVD may be treated with interventional procedures such as:
- Angioplasty - widens or clears the blocked vessel
- Stent - a tiny mesh device that supports the cleared vessel and keeps it open
- Atherectomy or thrombectomy - removes the blockage or obstruction
- Lifestyle changes
Additionally, your doctor will talk to you about making lifestyle changes. Some changes you can make to manage your condition include:
- Quitting smoking. Ask your doctor about smoking cessation programs available in your community.
- Exercising. Begin a regular exercise program, such as walking, which can aid the treatment of PVD. Patients who walk regularly can expect a marked improvement in the distance they are able to walk before experiencing leg pain.
- Eating a high-fiber, low-fat, low-cholesterol, low-sodium diet. Limit fat to 30 percent of your total daily calories. Saturated fat should account for no more than 7 percent of your total calories. Avoid trans fats, including products made with partially-hydrogenated and hydrogenated vegetable oils. If you are overweight, losing weight will help you lower your total cholesterol and raise your HDL (good) cholesterol. A registered dietitian can help you make the right dietary changes.
- Controlling diabetes, including seeing your doctor regularly and taking all medications as prescribed.
- Controlling your blood pressure, including following the advice listed in this section.
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Frequently Asked Questions
Who is at risk of developing PVD?
You are at greater risk for developing PVD if:
- You are a diabetic
- You are a smoker
- You are obese
- You have high blood pressure
- You have high cholesterol
- You have a family history of the disease
- You have an inactive lifestyle
- You have been diagnosed with heart disease
- You have had a stroke
- You are African-American
- You are over 50
What are the symptoms of PVD?
While many patients will not experience symptoms of PVD, some may notice:
- The presence of a dull, cramping pain in the hips, buttocks or calf muscles that occurs during physical activity and improves when resting (known as intermittent claudication)
- Numbness or tingling in the legs, feet or toes
- A burning or aching pain in the feet and toes while resting, especially at night while lying flat
- Changes in skin temperature in the legs, feet or toes
- Redness or other color changes in the skin
- Increased occurrence of infection
- Toe and foot sores that do not heal
- Erectile dysfunction
What other problems can occur from PVD?
If left untreated, patients with PVD can develop serious health problems, including:
- Heart attack
- Stroke
- Transient ischemic attack (TIA)
- Renal artery disease or stenosis
- Amputation
Is there a cure for PVD?
There is no cure for PVD, but by quitting smoking, exercising regularly, limiting fat and following a healthy diet, while managing your risk factors, you can help to reduce the progression of the disease.
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