Disease of the month: Peripheral vascular disease

This disease has a broad range of severity. Paul Gyseman highlights its complications.

It is estimated that in the UK, 20% of over 70s have peripheral vascular disease (PVD). However the anatomy of the peripheral circulation, what happens when the disease affects the relevant arterial systems, and how it impacts upon insurance underwriting practices as well as mortality and morbidity outcomes, is not widely known among advisers.

PVD is the name given to the condition that causes occlusions (blockages) to the peripheral arteries. These are generally regarded as those that do not supply blood to the heart, the aortic arch vasculature or the brain.

Essentially, these are the main arteries which supply the lower abdomen, the pelvis and the lower limbs. The aorta that arises from the left ventricle of the heart, arches and then runs down the centre of the body to the abdomen and then divides into two femoral arteries (branches), which supply the feet and legs with oxygen-rich blood flow. 

It is these femoral arteries that often get affected by PVD, resulting in a wide array of symptoms – ranging from just very mild discomfort when walking to, in the worst case scenario, amputation of the affected limb.

It can be a very unpleasant condition, but the good news is that treatment can be very effective alongside negating the adverse influence of other related risk factors. Similar to cardiovascular disease, atheroma builds up inside the peripheral arteries which then causes symptoms known as claudication.

Claudication is the term used to describe the pain that sufferers experience when walking. The degree of claudication usually ties in with the degree of the underlying disease. Other causes can be attributed to embolisms (blood clots), inflammation of the arteries (arteritis), and auto-immune conditions.

However, for a diagnosis to be made, there has to be certain protocol observed. Usually the first signs of the disease in a patient, who is suspected of having arterial occlusion, would be to check the pulses in the ankles and a general examination of the foot and leg. In addition, as part of the procedure, the blood pressure at the ankle would be measured and compared to the blood pressure reading in the arm.

This is known as the ankle/brachial pressure index (ABPI). If the pressure at the ankle is below that of the arm, then occlusive disease is suspected. The foot may also be blue in colour, cold and display sores or ulcers.