Peripheral Vascular Disease - Know the symptoms, mitigate the risks, get vital treatment

Puneet Khanna, MD, left, and Praveen Panguluri, MD
When we think of atherosclerosis — the build-up of fatty deposits on the inner walls of arteries, causing the arteries to narrow or become blocked— we usually associate it with cardiovascular (heart) disease (CVD). But the fact is, blocked arteries can occur throughout the body, including in the arms and legs, a condition called peripheral vascular disease (PVD) or peripheral artery disease (PAD).

“As many as 30 to 40 percent of people with CVD also have PVD,” says Puneet Khanna, MD, who is Board Certified in Interventional Cardiology and Cardiovascular Disease, the specialty that treats most PVD cases. 

The same risk factors apply to both conditions.

“The people at highest risk of getting PVD are those over age 50 who also have high cholesterol, diabetes, high blood pressure and who smoke,” says Praveen Panguluri, MD, Board Certified in Interventional Cardiology and Cardiovascular Disease.

What are the symptoms of PVD?

“Pain when walking — what’s called intermittent claudication — is the classic symptom,” Dr. Khanna explains. “Or you may feel tightness in the calves, thighs or buttocks, depending on which arteries are involved. And some patients feel their legs getting tired when they walk.”

“In more severe cases, we may see discoloration of the feet and lower extremities, or ulcers on the foot or leg that are slow to heal due to compromised circulation,” notes Dr. Panguluri.

“This is when patients can get into trouble because when the sore doesn’t heal, it can get infected and amputation becomes necessary,” Dr. Khanna warns, underscoring why timely diagnosis and treatment are so vital. Left untreated, PVD also increases the risk of heart attack and stroke, another reason to seek medical care.

How is PVD diagnosed?

“We start with a complete medical history and physical exam, checking the pulse in the feet and lower extremities,” Dr. Panguluri says. “If it’s diminished compared to other parts of the body, this may be a sign of PVD.”

“We also do a simple in-office test called an ankle brachial index, or ABI, in which we compare the blood pressure in the leg versus the arm,” Dr. Khanna continues. “If there’s a blocked peripheral artery, the pressure beyond the blockage is much lower. Like a garden hose with a kink, pressure is strong coming out of the tap but not at the end of the hose.”

“If ABI findings are abnormal, we’ll do ultrasound to look at the peripheral arteries and blood flow,” Dr. Panguluri says. “After that, we may consider CT, MRI or an angiogram to pinpoint blockages. It’s a graduated, stepwise approach.” 

How is PVD treated?

“We generally start with a conservative approach,” Dr. Khanna says. “If claudication is the major symptom, we recommend lifestyle modifications, such as smoking cessation and dietary changes, add aspirin or another blood thinner to aid circulation, and put the patient on a walking program.

“It takes discipline because it hurts to walk,” he continues. “We encourage patients to walk daily, stop when it hurts, then resume once the pain subsides. They can start with three to five minutes and work up to at least 30 minutes daily. Eventually, they’ll be able to walk through any discomfort without stopping.

“What happens is that the body builds its own bypasses, called collateral circulation,” he adds, noting that regular walking forces the body to adapt to a lack of blood supply by building tiny channels to substitute for bigger blocked arteries. 

“In patients with a non-healing ulcer or for whom conservative approaches don’t relieve symptoms, then we talk about opening a blocked artery using a minimally invasive endovascular approach or doing surgery to bypass a blockage,” Dr. Khanna says.

“As interventional cardiologists, Dr. Khanna and I focus on these endovascular approaches, using catheters to access and open up blockages from inside the artery,” Dr. Panguluri says. “When open surgery is indicated, it is performed by Board Certified Vascular Surgeon Alan Williamson, MD, or another surgeon.

“The appropriate treatment depends on the anatomical features of the blockage and its location,” he adds. “But we almost always try the endovascular approach first; it requires only a 2mm incision to insert the catheter and recovery is faster.” 

“Just 15 years ago, about 95 percent of PVD cases were addressed surgically and only five to ten percent were done endovascularly,” Dr. Khanna notes. “But today that ratio has flipped, thanks to advances in minimally invasive technology and techniques.”

Among these advances (some of which Dr. Khanna was involved in developing) are:

  • Balloon angioplasty and stent placement in which the artery is dilated and a stent put in to prop the artery open
  • Directional artherectomy, in which a catheter containing a cutter shaves away, catches and removes the plaque inside an artery before a stent is placed
  • Orbital artherectomy, in which a burr-like device covered in industrial diamonds breaks up hard, calcified plaque into particles smaller than blood cells, which are then flushed out by the body’s immune system. Once completed, the artery is expanded with a balloon with a drug coating, minimizing the risk of a blockage recurring
  • Laser artherectomy, in which laser energy is used to vaporize a blockage
  • Lithoplasty balloon, which uses sound waves to break up plaque and remove it via catheter     

“There are a lot of new tools becoming available to treat patients with PVD blockages,” Dr. Khanna notes. “Most of these procedures take only 30 to 90 minutes, can be performed under mild sedation, and the patient goes home three hours later. 

“But the best approach remains prevention,” he adds. “Lower your cholesterol, manage blood pressure, eat a heart-healthy diet, stop smoking, exercise regularly and maintain a healthy weight.”

For more information or to contact Eisenhower Desert Cardiology Center, call 760.346.0642, or visit