how much blockage to arteries causes pvd pain?

Answer 1

Let's condense things down a bit...

DIfferent patients will be symptomatic at different degrees of narrowing. In general, 60-70% narrowing produces symptoms of claudication. A frail elderly person may not be symptomatic (due to a low level of activity) until the narrowing is worse.

Things YOU can do:
1) Stop smoking, completely
2) If diabetic, control your sugars
3) Normalize your cholesterol levels (diet, exercise, meds)
4) Exercise. Walk until the pain hits, stop & rest, then restart.
5) Be evaluated by a vascular surgeon

The causes of PVD are exactly the same as for coronary artery disease. Same risk factors. People with PVD are at increased risk of CAD.

Answer 2

1

Answer 3

The exact percentage of blockage of arteries is not known, it is mostly when the symptoms starts by which PVD diagnosis is made and it's already too late. This article will help you out:

About 8 million Americans have PVD, but only about 1.2 to 1.5 million have been diagnosed, says Rod Raabe, M.D., national chairman of Legs for Life, a PVD screening campaign.

Since the majority of PVD sufferers are over 50, many brush off the nagging pain in their legs and buttocks as a sign of aging or lack of exercise.

But they shouldn’t. Most people with PVD can control the disease and its symptoms with minimal changes in diet or exercise, medications or highly effective surgical options. Left to progress, however, the disease can cause severe blockages in leg arteries, leading to ulceration, amputations, dangerous clotting and a higher risk of stroke.


How it happens
PVD, also called peripheral arterial disease, is similar to the narrowing or hardening of the arteries around the heart known as artherosclerosis. In PVD, plaque — made of fatty substances, cholesterol and calcium — builds up on the walls of the arteries that bring oxygen-rich blood from the heart to the limbs. This plaque buildup narrows the arteries and reduces blood flow.

Blockages can occur at many levels on the road from the heart to the toes, says Walter Kwass, M.D., section chief of Vascular Surgery at the Hospital of Saint Raphael and a board-certified vascular surgeon.

Narrowing at the aorta — the main abdominal artery — can cause symptoms in the entire leg and buttocks.

Blockages can also occur in the iliac branches off the aorta, in the femoral artery in the thigh, and in smaller arteries lower in the leg, he explains. It rarely affects the arms. “The symptoms vary in severity depending on the number of levels that are involved,” he adds.

The most common symptom is intermittent claudication, a phenomenon similar to angina in the heart, says Kenneth Hershon, director of research at North Shore Diabetic and Endocrine Associates of New Hyde Park, N.Y. He treats diabetics who are at higher risk of PVD.

Named for the Roman Emperor Claudius, who had a congenital deformity that caused him to limp, claudication shows itself in the very specific leg pain PVD sufferers describe.

“Patients can usually nail it down very distinctly,” Kwass says. “They’ll say, ‘I can walk three blocks before it hurts.’ Or, ‘I can only walk a half a block.’ ”


How it strikes
Unlike a pulled muscle or a tingling nerve problem, PVD pain is often described as a “tight, squeezing feeling,” says Charles Beckman, M.D., a cardiovascular surgeon and attending physician at the Hospital of Saint Raphael, who’s board-certified in cardiovascular surgery. “It’s as if there’s a band around the calf, as if they had a blood pressure cuff pumped very tight around their leg,” he explains.

The pain starts with activity, when more blood pushes through the arteries. It usually goes away as soon as the patient stops walking or exercising. Doctors can pinpoint blockages by searching for a pulse in the affected limb and comparing it to pulses found higher in the leg and in the arm.

Health histories and lifestyle cues also tip off doctors. Smokers and people with a history of high cholesterol or high blood pressure are considered at-risk, Hershon says. Diabetics account for about 50 percent of cases in the New Haven area, Kwass estimates.

While obesity doesn’t seem to cause PVD, he says PVD patients are often overweight. The disease can be hereditary. “Family history is very important,” Kwass adds.

If PVD progresses untreated, patients can develop rest pain, which usually occurs at bedtime. The heart slows down and the legs are elevated, so there is less blood flow to the feet. Some patients report pain or a burning sensation in the toes and feet.

In the most severe, untreated cases and some sudden cases, poor circulation and clotting can cause tissue damage and tissue death. Patients can suffer open sores that don’t heal and gangrene that can lead to amputation. PVD leads to 100,000 amputations each year, according to the Vascular Disease Foundation, a non-profit awareness group.

Milford retiree David Maguschak was on an Alaskan cruise last September when he showed signs of PVD.

“I thought it was just from walking with new sneaks or from standing a lot,” remembers the 66-year-old who had no prior symptoms.

The ship’s doctor suggested it was simple tissue swelling, and his own doctor agreed during a visit a few days later. Within days, however, Maguschak noticed the skin on his foot turning red and then bluish.

He was sent to Saint Raphael’s, where doctors found a blockage behind his knee. Surgeons did a vein transplant and had to remove the toes on his right foot. Maguschak says he believes prompt attention saved his foot and leg. “It was something that happened rapidly. It was a surprise to me,” he says. “Thank God I got home.”


How it’s treated
Most PVD patients have much more time and several other options to help slow the disease’s progression and lessen symptoms, Kwass says. “How you treat it has to do with who the patient is,” he says.

Since smoking has been shown to promote narrowing of the arteries and boost harmful cholesterol, Hershon has three pieces of advice for smokers with PVD: “The first treatment is stop smoking. The second treatment is stop smoking. And the third treatment ... well, you get the idea.”

Ironically, the best treatment for leg pain during walking is more walking, Kwass says. He often prescribes Buerger’s exercising — a pattern of walking until the pain starts, taking a few extra steps, resting, and then continuing to walk. The idea is to work the arteries, which should cut down on plaque production.

He also recommends diet changes to decrease saturated fat and get cholesterol levels under control.

Some medications seem to help PVD sufferers, but they have their downside, too. Pentoxyphylline leaves blood slippery and able to slide through narrow spaces, and it has few side effects or drug interactions. But the drug rarely improves a patient’s walking distance more than 50 percent, which is of little help for someone who can only walk a half-block, Kwass says.

A newer drug, Cilostazol, appears to be more effective in staving off claudication. But it has more significant side effects, including heart palpitations and headache, he says. It also has several drug interactions, and people with a history of heart failure can not use it.

The final, and often best, option for PVD patients is surgical or interventional treatment. “You should have a certain amount of symptoms before you do anything surgical,” Beckman says.

In some cases, doctors find balloon angioplasty helpful. A small deflated balloon attached to a catheter is threaded into the affected artery. Doctors inflate the balloon at the narrowest point to break up plaque.

Surgeons can also insert a stent, a tiny, wire mesh tube placed in an artery cleared by angioplasty. The stent forms a rigid support to hold the clogged artery open and prevent future clogs.

Many patients find relief through vein bypass surgery. The surgical team — which can include a vascular surgeon, interventional radiologist and other cardiac specialists — map out a plan with an angiogram. Dye is injected into the artery at the groin to clearly show the point of blockage.

In a typical scenario, the surgeon harvests a healthy vein from the inner leg. The top end is attached to the femoral artery and the lower end is attached to the artery below the knee or at the back of the foot, Kwass says.

The process takes between two and five hours, and the patient is usually placed in the intensive care unit or a vascular unit for observation the day after surgery. Rehabilitation begins right away.

“It’s possible to be walking on the first day after surgery,” he says.

Patients usually spend a few days in the hospital and then benefit from a short-term stay at a rehabilitation center, where they learn how to exercise the leg. Patients generally see a doctor every three months for the first year to make sure the vein graft is working properly.

Weiss went through drug therapy and stress tests before she and her doctors decided on an aortic bypass. She said it took about four months before she felt normal again.

“It was a little bit more involved than I thought it was going to be,” she says. “The blockage was farther than they expected, but it worked.”

Weiss also took a hard look at her lifestyle. A smoker since she was 18, she smoked her last cigarette on the day of her surgery. She’s also eating healthier foods, hoping to bring down a cholesterol level that once hit 298.