Interdisciplinary Departments
Cardiology, Radiology, Vascular Surgery, Endovascular Medicine

Cardiology:
Inga Robbins, MD

Radiology:
Howard Naidech, MD

Endovascular Medicine
Manu Rajachandran, MD, Chair

What is Peripheral Vascular Disease?
Peripheral vascular disease (PVD) has been receiving increasing attention in the news in recent years, with the growing knowledge in the medical community that this disease has been in the past seriously under-diagnosed and under-treated. Recent studies suggest that physicians have tended to overlook the disease due to its protean manifestations. One multicenter study concluded that although prevalence of PVD in primary care practices was high, physician awareness of the disease was relatively low. Patients seemed to have a higher awareness of their vascular condition than their physicians did.

PVD in the U.S. is estimated to affect 8 to 12 million patients a year; some experts in the field believe this might be an under-estimate. The disease is associated with significant cardiovascular morbidity and mortality, with a high rate of fatal and non-fatal cardiovascular events such as MI, stroke, and progressive ischemic end-organ dysfunction.

Since atherosclerosis is the most common cause of PVD, patients with PVD have a rate of cardiovascular mortality that is 3 to 5 times higher than age-matched controls. The cardiac mortality in symptomatic PVD is estimated to be 50% at 10 years. The reduction in quality of life from global vasculopathy in many patients can thus be significant.

What are the Symptoms of Peripheral Vascular Disease?
Recent studies suggest that only 11% of patients with confirmed diagnosis of PVD had symptoms of classic claudication. There is a large pool of data to suggest that up to 50% of patients with PVD experience no symptoms at all.

The classic symptoms of claudication, or leg pain with ambulation, include: onset of pain with exertion, crampy, achy/burning sensation in the muscles of the calf or thigh, relief of pain with rest, and some measure of reproducibility of symptoms at specified distances on level ground.

What is the Prognosis for Peripheral Vascular Disease?
The ABI has been demonstrated in many studies to be a powerful independent prognosticator of cardiovascular mortality in patients with PVD. Symptomatic PVD with and abnormal ABI carries a 30% 5-year mortality and 50% 10-year mortality from cardiovascular causes. Patients with asymptomatic PVD, characterized as an abnormal resting ABI, have a 2 to 5 fold higher risk of cardiovascular risk than age-matched patients with normal ABI studies.

How is Peripheral Vascular Disease Diagnosed?
The blood pressure in the pedal artery divided by the higher of two blood pressures in the brachial arteries, constitutes the ABI (Ankle Brachial Index), which is the basis for diagnosing and risk stratifying patients with peripheral vascular disease.

A normal ABI is >1.0
Mild PVD is characterized by an ABI of 0.80-0.99
Moderate PVD is characterized by an ABI of 0.50-0.79
In severe PVD, the resting ABI is usually less than 0.50

The test is simple to perform and has great prognostic value in the management of these patients.