A systematic examination of the peripheral vasculature is critical for proper evaluation. Peripheral signs of peripheral vascular disease are the classic "five P's," as follows:
Paralysis and paresthesia suggest limb-threatening ischemia and mandate prompt evaluation and consultation. Assess the heart for murmurs or other abnormalities. Investigate all peripheral vessels, including carotid, abdominal, and femoral, for pulse quality and bruit. Note that the dorsalis pedis artery is absent in 5-8% of normal subjects, but the posterior tibial artery usually is present. Both pulses are absent in only about 0.5% of patients. Exercise may cause the obliteration of these pulses. The Allen test may provide information on the radial and ulnar arteries. The skin may have an atrophic, shiny appearance and may demonstrate trophic changes, including alopecia; dry, scaly, or erythematous skin; chronic pigmentation changes; and brittle nails. Advanced PVD may manifest as mottling in a "fishnet pattern" (livedo reticularis), pulselessness, numbness, or cyanosis. Paralysis may follow, and the extremity may become cold; gangrene eventually may be seen. Poorly healing injuries or ulcers in the extremities help provide evidence of preexisting PVD. The ABI can be determined at the bedside. Pressure is measured with Doppler ultrasonography at the brachial artery and at the posterior tibialis artery. The ankle systolic pressure is divided by the brachial pressure, both as measured in the supine position. Normally, the ratio is greater than 1. In severe disease, it is less than 0.5. A semiquantitative assessment of the degree of pallor also may be helpful. While the patient is supine, the degree of pallor is assessed. If pallor manifests when the extremity is level, the pallor is classified as level 4. If not, the extremity is raised 60°. If pallor occurs in 30 seconds or less, it is a level 3; if in less than 60 seconds, level 2; and if in 60 seconds, level 1. If no pallor occurs within 60 seconds, it is level 0.
Medically reviewed by Judith Marcin, M.D. — Written by Anna Giorgi — Updated on September 17, 2018 We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process. What is peripheral vascular disease? Peripheral vascular disease (PVD) is a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm. This can happen in your arteries or veins. PVD typically causes pain and fatigue, often in your legs, and especially during exercise. The pain usually improves with rest. It can also affect the vessels that supply blood and oxygen to your:
In PVD, blood vessels become narrowed and blood flow decreases. This can be due to arteriosclerosis, or “hardening of the arteries,” or it can be caused by blood vessel spasms. In arteriosclerosis, plaques build up in a vessel and limit the flow of blood and oxygen to your organs and limbs. As plaque growth progresses, clots may develop and completely block the artery. This can lead to organ damage and loss of fingers, toes, or limbs, if left untreated. Peripheral arterial disease (PAD) develops only in the arteries, which carry oxygen-rich blood away from the heart. According to the CDC, approximately 12 to 20 percent of people over age 60 develop PAD, about 8.5 million people in the United States. PAD is the most common form of PVD, so the terms are often used to mean the same condition. PVD is also known as:
What is peripheral artery disease? » The two main types of PVD are functional and organic PVD. Functional PVD means there’s no physical damage to your blood vessels’ structure. Instead, your vessels widen and narrow in response other factors like brain signals and temperature changes. The narrowing causes blood flow to decrease. Organic PVD involves changes in blood vessel structure like inflammation, plaques, and tissue damage. Your vessels naturally widen and narrow in response to your environment. But in functional PVD, your vessels exaggerate their response. Raynaud’s disease, when stress and temperatures affect your blood flow, is an example of functional PVD. The most common causes of functional PVD are: Organic PVDOrganic PVD means there’s change in the structure of your blood vessels. For example, the plaque buildup from arteriosclerosis can cause your blood vessels to narrow. The primary causes of organic PVD are:
Additional causes of organic PVD include extreme injuries, muscles or ligaments with abnormal structures, blood vessel inflammation, and infection. For many people, the first signs of PVD begin slowly and irregularly. You may feel discomfort like fatigue and cramping in your legs and feet that gets worse with physical activity due to the lack of blood flow. Other symptoms of PVD include: Tell your doctor if you’re experiencing any symptoms of PVD. These symptoms are commonly brushed aside as the results of aging, but delayed diagnosis and treatment can cause further complications. In extreme cases of blood loss, gangrene, or dead tissue, can occur. If you suddenly develop a cold, painful, pale limb with weak or no pulses, this is a medical emergency. You will require treatment as soon as possible in order to avoid severe complications and amputation. ClaudicationThe most common symptom of PVD and PAD is claudication. Claudication is lower limb muscle pain when walking. You may notice the pain when you are walking faster or for long distances. It usually goes away after some rest. When the pain comes back, it may take the same amount of time to go away. Claudication occurs when there’s not enough blood flow to the muscles you’re using. In PVD, the narrowed vessels can only supply a limited amount of blood. This causes more problems during activity than at rest. As your PAD progresses, symptoms will occur more frequently and get worse. Eventually, you may even experience pain and fatigue during rest. Ask your doctor about treatments to help improve blood flow and decrease pain. Complications from undiagnosed and untreated PVD can be serious and even life-threatening. Restricted blood flow of PVD can be a warning sign of other forms of vascular disease. Complications of PVD can include: The most serious complications involve the arteries bringing blood to the heart and brain. When these become clogged, it can lead to heart attack, stroke, or death. Early diagnosis is the first step to successful treatment and it can prevent life-threatening complications. Tell your doctor if you have any of the classic symptoms of PVD, such as claudication. Your doctor will also ask about your medical history and perform a physical exam. The physical exam can include measuring the pulses in your legs and feet. If your doctor hears a whooshing sound through their stethoscope, it could mean a narrowed blood vessel. They may order more specific tests to diagnose PVD. These tests include: The two main goals of PVD treatment is to stop the disease from progressing and to help you manage your pain and symptoms so you can remain active. The treatments will also lower your risk for serious complications. First-line treatment typically involves lifestyle modifications. Your doctor will suggest a regular exercise program that includes walking, a balanced diet, and losing weight. If you smoke, you should quit. Smoking directly causes reduced blood flow in vessels. It also causes PVD to get worse, as well as increasing your risk of heart attack and stroke. If lifestyle changes alone aren’t enough, you may need medication. Medications for PVD include:
Significant artery blockages may require surgery like angioplasty or vascular surgery. Angioplasty is when your doctor inserts a catheter or long tube into your artery. A balloon on the tip of the catheter inflates and opens up the artery. In some cases, your doctor will place a small wire tube in the artery, called a stent, to keep it open. Vascular surgery allows for blood to bypass the narrow area through vein grafting. If diagnosed early, many cases of PVD will respond to lifestyle treatments. One way to measure improvement is to measure how far you can walk without pain. With effective treatment, you should be able to gradually increase the distance. Contact your doctor if your symptoms get worse or you experience any of the following:
How PVD impacts people around the worldLast medically reviewed on September 17, 2018 Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.
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What do physical findings on the lower extremities associated with peripheral vascular disease include?
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