Peripheral Vascular Disease: Warning Signs, Causes, and Treatment Options

Your legs shouldn’t hurt when you walk. If they do, and the pain eases when you stop, that’s not just aging or being out of shape. It could be a warning sign of peripheral vascular disease (PVD), a condition that affects the blood vessels outside your heart and brain. Left unmanaged, PVD can lead to serious complications, including non-healing wounds, limb loss, and a significantly higher risk of heart attack and stroke. The good news: when caught early, it’s very treatable.

What Is Peripheral Vascular Disease?

Peripheral vascular disease is an umbrella term for conditions that affect blood vessels outside the heart and brain. It includes both arterial and venous disorders, and most commonly affects the legs. PVD encompasses:

• Peripheral Artery Disease (PAD): Narrowing of the arteries due to plaque buildup (atherosclerosis), restricting blood flow to the limbs.
• Venous Insufficiency: A condition where the veins struggle to return blood from the legs back to the heart, causing pooling, swelling, and varicose veins.
• Varicose Veins: Enlarged, twisted veins that appear just under the surface of the skin, typically in the legs.
• Deep Vein Thrombosis (DVT): A blood clot that forms in a deep vein, usually in the leg, which can become life-threatening if the clot travels to the lungs.

Because PVD covers both arterial and venous disease, patients can experience a wide range of symptoms depending on which vessels are affected. Some have PAD-related arterial blockages. Others present with vein problems. Many have both.

Warning Signs You Shouldn’t Ignore

PVD is often called a “silent condition” because many people don’t notice symptoms until the disease has progressed. When signs do appear, they vary depending on whether arteries or veins are primarily affected.

Arterial Warning Signs (PAD)

• Claudication: Cramping, aching, or fatigue in the legs or buttocks during physical activity that eases with rest.
• Persistent leg weakness or numbness, especially during activity.
• Coldness in one lower leg or foot compared to the other side.
• Sores or wounds on the feet or legs that are slow to heal or won’t heal at all.
• Pale, bluish, or shiny skin on the legs and feet.
• Weak or absent pulse in the legs or feet.

Venous Warning Signs

• Painful, bulging varicose veins visible near the skin’s surface.
• Heavy, swollen, or achy legs, especially after prolonged standing or sitting.
• Itchy or dry skin on the lower legs.
• Leg wounds that will not heal, particularly near the ankle.
• Skin discoloration or hardening around the lower leg.

Risk factors for both arterial and venous PVD include smoking, diabetes, high blood pressure, high cholesterol, obesity, prolonged sitting or standing, and a personal or family history of cardiovascular disease. If any of these apply to you alongside any of the symptoms above, it’s worth having a conversation with a vascular specialist.

How Is Peripheral Vascular Disease Diagnosed?

A thorough evaluation is the first step. Depending on your symptoms and risk profile, your care team may recommend:

• Ankle-Brachial Index (ABI): A non-invasive test that compares blood pressure in your ankle to your arm, used to screen for arterial disease.
• Duplex Ultrasound: Imaging that evaluates blood flow and vein valve function, useful for both arterial and venous conditions.
• CT Angiography: A detailed imaging scan that maps the arteries and identifies blockages or abnormalities.

At AMS, all vascular testing is performed in our IAC-accredited vascular lab, with CT scan capabilities on-site, so patients can get comprehensive answers without being sent elsewhere.

Treatment Options for Peripheral Vascular Disease

The right treatment depends on which type of PVD you have, how far it has progressed, and your overall health. Here’s what a comprehensive approach typically looks like:

Lifestyle Modifications

For both arterial and venous disease, lifestyle changes can make a meaningful difference. Quitting smoking is the single most impactful step for arterial PVD. A structured walking program, weight management, dietary changes, and avoiding prolonged sitting or standing all help improve circulation and reduce symptom severity.

Medications

Depending on your condition, your doctor may prescribe blood thinners, cholesterol-lowering medications, drugs to improve blood flow, or anticoagulants to reduce clotting risk. For venous disease, compression therapy is often part of the initial management plan.

Minimally Invasive Interventions

When lifestyle and medication aren’t enough, modern interventional procedures can restore circulation and relieve symptoms, often without a hospital stay:

• Angioplasty and Stenting (Arterial): A small balloon is used to open a narrowed artery, and a stent is placed to keep it open.
• Catheter-Based Arterial Treatments: Advanced catheter techniques restore blood flow to the limbs with less discomfort and faster recovery than traditional surgery.
• Vein Ablation: A minimally invasive procedure that uses heat or laser energy to close off damaged veins, redirecting blood flow to healthier vessels.
• Sclerotherapy: A solution is injected directly into problem veins, causing them to collapse and fade.

Most of these procedures are performed in-office, with patients returning to their normal routines within hours.

Surgical Options

In more advanced arterial cases, bypass surgery using a graft can reroute blood around a blocked artery. For severe venous disease or DVT, surgical intervention may also be required. These are typically reserved for cases where minimally invasive options aren’t sufficient.

What Happens If PVD Goes Untreated?

Untreated arterial PVD can progress to critical limb ischemia, where blood flow is so restricted that tissue begins to die. This can lead to non-healing wounds, serious infection, and in severe cases, amputation. On the venous side, untreated disease can cause chronic pain, skin breakdown, leg ulcers, and blood clots. Both forms significantly raise the risk of heart attack and stroke. Early diagnosis and treatment aren’t just about symptom relief; they’re about protecting your long-term health.

Getting Evaluated at AMS

If you’re experiencing leg pain, unexplained swelling, varicose veins, or wounds that won’t heal, don’t wait for symptoms to get worse. At AMS, our team of board-certified vascular specialists diagnoses and treats the full spectrum of peripheral vascular disease at our Horsham and North Wales locations. All testing is performed in our IAC-accredited vascular lab, and most procedures are done in-office with no hospital stay required.

Learn more about our vascular care at amsvascular.com and schedule your consultation today.

Frequently Asked Questions About Peripheral Vascular Disease

What is the difference between PVD and PAD?

Peripheral artery disease (PAD) is a type of peripheral vascular disease. PVD is the broader category that covers all disorders of the blood vessels outside the heart and brain, including both arteries and veins. PAD specifically refers to arterial narrowing from plaque buildup, while PVD also includes venous conditions like varicose veins, venous insufficiency, and deep vein thrombosis.

Can peripheral vascular disease be reversed?

PVD cannot be fully reversed, but it can be effectively managed. With the right combination of lifestyle changes, medications, and procedures, many patients see significant improvement in symptoms and quality of life. For venous disease, treatments like ablation and sclerotherapy provide lasting relief for the majority of patients. Early intervention gives you the most options and the best outcomes.

Who is most at risk for PVD?

People over age 50 are at higher risk, particularly those who smoke or have a history of smoking. Diabetes, high blood pressure, high cholesterol, obesity, and a personal or family history of cardiovascular disease all increase your risk for arterial PVD. Prolonged sitting or standing, pregnancy, and a family history of varicose veins are risk factors for venous disease. If multiple risk factors apply to you, talk to your doctor about screening.

Are vein treatments covered by insurance?

Many vascular treatments are covered by insurance, particularly when there is a documented medical need. Coverage varies by plan and procedure. Our team helps patients navigate insurance requirements and understand their options before moving forward with any treatment.

Do I need a referral to be seen for vascular disease?

Referrals are welcome but not always required. If you’re experiencing symptoms or have risk factors for PVD, you can contact our team directly to discuss next steps and schedule a consultation.