Peripheral Vascular Disease

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• Vascular Surgery
• Medical Center Campus
• Main Pavilion, Level 5
• 111 Colchester Avenue
  Burlington, VT, 05401
• Phone: 802-847-4548
• 1-877-817-5030
• Monday-Friday, 8 AM-5 PM
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Lower extremity peripheral vascular disease -- also known as peripheral vascular disease (PVD) or peripheral arterial disease (PAD) – results from blockages in the arteries that restrict blood flow to your limbs.

Lower extremity peripheral vascular disease refers to a wide range of symptoms affecting a large number of patients. The disease occurs progressively over time. Patients may not experience symptoms for several months to a year.

The disease tends to manifest itself in the following ways:

• You may have blocked arteries with no symptoms

• You may have blocked arteries with claudication, which is leg pain while walking or exercising. The pain tends to first appear as a cramping in the calf. Claudication is primarily a functional problem and is not life-threatening.

• You may have blocked arteries with severe problems. For example, you may experience pain in the feet or legs while at rest, and suffer from debilitating symptoms. This form of the disease can pose a serious health threat to your limbs.

If you are experiencing any symptoms, you should discuss them with your primary care provider. Your primary physician may then refer you to a vascular surgeon, who can discuss whether or not to start treatment, as well as all the options for therapy. The decision to start treatment is based on the severity of your symptoms and how they affect your lifestyle. 

Causes of lower extremity peripheral vascular disease

Lower extremity peripheral vascular disease results from blockages in the arteries. These blockages are caused by atherosclerosis, which is primary related to the following risk factors:

• Smoking
• High cholesterol
• High blood pressure
• Diabetes
• Family history of atherosclerosis, peripheral vascular disease or claudication

Lower extremity peripheral vascular disease care at Fletcher Allen

At Fletcher Allen, our highly skilled vascular surgeons provide expert care for patients with lower extremity peripheral vascular disease. Our modern, state-of-the-art facility includes a nationally accredited non-invasive diagnostic laboratory, where diagnostic tests are done.

We provide convenient care and services for patients. Patients are often able to visit with a surgeon and have an imaging study the same day, reducing the need to travel for several appointments.

Our vascular surgeons use the latest technology and minimally invasive procedures to treat peripheral vascular disease. In addition, we are committed to personalized, patient-centered care: every patient who comes through our doors is seen and assessed by a vascular surgeon, who is involved throughout their care.

Our surgeons also provide outreach services at community hospitals in Vermont and northern New York, bringing advanced expertise to outlying areas. Our Vascular Surgery office can tell you whether clinics are offered at a hospital near you.

As a university hospital and health system in partnership with the University of Vermont, we provide care backed by research, which means you can be assured that your care is based upon the latest thinking in the field. We are committed to patient education, helping you become as informed as possible throughout your care.

Diagnosis: Peripheral Vascular Disease (PVD)/Peripheral Arterial Disease (PAD)

Fletcher Allen’s vascular technologists and imaging specialists are specially trained in the latest techniques to diagnose vascular problems. Diagnostic tests are performed in our vascular diagnostic laboratory located within the Vascular Surgery offices. The process of diagnosis may involve the following:

• Pulse volume recording -- This measures the volume of blood at various points in your legs.

• Ankle-brachial index -- A test that evaluates the circulation in the legs, by comparing blood pressure in the ankle and the arm.

• Duplex ultrasound -- This technique combines both conventional ultrasound that shows the structure of the blood vessels with Doppler ultrasound, which allows for measurement of blood flow.

Non-invasive vascular laboratory

Diagnosing vascular problems typically begins in our nationally accredited non-invasive diagnostic laboratory, conveniently located in the Vascular Surgery clinic at Fletcher Allen’s Ambulatory Care Center. Patients are often able to see a doctor and have a non-invasive test during a single visit.

The lab is staffed by registered vascular technologists -- highly skilled specialists with advanced training in non-invasive vascular imaging and testing. By focusing solely on vascular problems, these technologists bring an in-depth knowledge to the diagnosis of vascular patients.

The lab offers imaging and testing for the full range of vascular problems affecting all areas of the body. It provides two main types of testing -- physiological studies and ultrasound imaging. Both are non-invasive tests that are usually painless and relatively quick.  They enable your physician to decide whether additional, more invasive tests are needed. These studies also can identify problems such as arterial atherosclerosis or vein disease.

• Physiological studies -- Studies that measure the amount of blood traveling through the vessels with and without exercise. They help determine if blockages exist.

• Ultrasound imaging -- An imaging study that uses sound waves to produce a video image of your blood vessels. Ultrasounds are used to check for a potential aneurysm, as well as blocked blood vessels in the neck, abdomen or extremities. In some cases, it may be the only test necessary to determine the need for an operation or stenting procedure. 

Treatment: Peripheral Vascular Disease (PVD)/Peripheral Arterial Disease (PAD)

Treatment for lower extremity peripheral vascular disease involves modifying the behaviors that increase risk for the disease -- through changes such as smoking cessation, or reducing high cholesterol or high blood pressure.

At Fletcher Allen, our specially trained vascular surgeons offer expert care in a personalized manner, working closely with patients and their families. We offer the latest surgical treatments for peripheral vascular disease, as well as medical management and help with lifestyle modifications.

We are committed to patient education through all stages of your treatment. We want to make sure you and your family have all the information you need to make the best decisions about your care.

Non-Surgical Treatments

• Lifestyle Changes -- Atheroscelosis, an underlying cause of claudication and peripheral artery disease, often results from unhealthy habits and lifestyles. At Fletcher Allen, we are dedicated to patient education and techniques to help you change your habits and adopt a healthy lifestyle. Changes such as smoking cessation, exercise and weight loss will help improve your symptoms. Our vascular team will help you access the resources you need to modify your lifestyle.

• Medications -- Medication can be an effective option for treating claudication. At Fletcher Allen, we offer the full range of medical therapies and the latest pharmaceutical products available to treat your problem. Our vascular team helps patients manage their condition medically. Cilostazol (Pletal) and Trental (Pentoxifylline) may be prescribed to help improve blood flow and reduce pain while walking. In addition, statins, which help lower cholesterol, may be recommended. Medications to control high blood pressure also may be useful.

• Surgery -- Our highly trained vascular surgeons perform the latest surgical techniques to treat lower extremity peripheral vascular disease. Patients can be assured of working with experienced and knowledgeable surgeons, with access to the latest, cutting-edge technology.  There are two main types of surgery performed for this disease. They include:

• Angioplasty and Stenting -- With this minimally invasive procedure, vascular surgeons insert a catheter with a special balloon on the end into the blood vessels. The catheter is guided to the blocked area in the leg. Once in place, the balloon is inflated and deflated several times to widen the damaged artery.  Once open, the surgeon may place a stent -- a tiny wire mesh tube -- in the artery to keep it open and allow blood to flow more freely.

• Bypass Surgery -- Bypass surgery is an open surgical procedure used to treat claudication and peripheral artery disease. Vascular surgeons use a variety of methods to re-route arterial blood flow around the blockage. This creates a new pathway for blood to flow around the narrowed or blocked artery in your leg.