Can Peripheral Vascular Disease (PVD) cause neuropathy?

From the Guidelines

Yes, Peripheral Vascular Disease (PVD) can cause neuropathy, specifically ischemic neuropathy, due to reduced blood flow to the nerves, leading to nerve damage and symptoms such as numbness, tingling, and pain. PVD restricts blood flow to the extremities, particularly the legs, which can lead to ischemic neuropathy when nerves don't receive adequate oxygen and nutrients. This type of neuropathy typically causes symptoms like numbness, tingling, burning sensations, and pain in the affected limbs. The development of neuropathy in PVD patients is gradual and correlates with disease severity, as noted in studies such as 1. The underlying mechanism involves nerve damage from reduced microcirculation to nerve fibers, leading to axonal degeneration. This ischemic neuropathy differs from diabetic neuropathy, though both conditions often coexist in patients with diabetes. Management focuses on treating the underlying vascular disease through lifestyle modifications (smoking cessation, exercise, healthy diet), medications to improve circulation (antiplatelet drugs, statins), and in severe cases, revascularization procedures. Controlling risk factors like diabetes, hypertension, and hyperlipidemia is essential for preventing progression of both PVD and associated neuropathy, as recommended in guidelines such as 1 and 1.

Key Points to Consider

• PVD can cause ischemic neuropathy due to reduced blood flow to the nerves
• Symptoms of ischemic neuropathy include numbness, tingling, burning sensations, and pain in the affected limbs
• Management of PVD and associated neuropathy involves lifestyle modifications, medications to improve circulation, and revascularization procedures in severe cases
• Controlling risk factors like diabetes, hypertension, and hyperlipidemia is crucial for preventing progression of both PVD and associated neuropathy

Recommendations for Clinical Practice

• Annual foot examinations for individuals with diabetes to identify high-risk foot conditions, including assessment of protective sensation, foot structure and biomechanics, vascular status, and skin integrity, as recommended in 1
• Initial screening for peripheral vascular disease should include a history for claudication and an assessment of the pedal pulses, with consideration of obtaining an ABI, as many patients with PAD are asymptomatic, as noted in 1 and 1

From the Research

Relationship Between PVD and Neuropathy

• Peripheral Vascular Disease (PVD) can cause neuropathy, as evidenced by studies that have investigated the relationship between the two conditions 2, 3, 4.
• A study published in 1995 found that atherosclerotic PVD can cause muscle denervation and is associated with the development of a multifocal predominantly motor neuropathy, which is most likely ischemic in etiology 2.
• Another study published in 1996 examined the pathological findings in nerves from acutely and chronically ischemic amputated legs with non-diabetic severe PVD, and found that chronic PVD nerves revealed considerable variations in the density of myelinated nerve fibers, demyelination, and remyelination, among other changes 3.
• A more recent study published in 2024 found that patients with PVD and neuropathy have an increased risk of amputation, revascularization, and death, and that expanding neuropathy screening in vascular surgery clinic visits may help to identify patients at higher risk 4.

Mechanisms and Risk Factors

• The mechanisms underlying the development of neuropathy in PVD are not fully understood, but are thought to involve ischemia, inflammation, and endothelial dysfunction 5, 3.
• Diabetes is a significant risk factor for the development of neuropathy in PVD, and patients with diabetes and PVD are at increased risk of amputation and other adverse outcomes 5, 4.
• Other risk factors for neuropathy in PVD include age, sex, and the presence of other vascular diseases 4.

Screening and Diagnosis

• Screening for neuropathy in patients with PVD can help identify those at increased risk of amputation, revascularization, and death 4.
• The Michigan Neuropathy Screening Instrument (MNSI) is a useful tool for screening for neuropathy in patients with PVD, and can help identify patients with abnormal nerve function 4.
• Early diagnosis and treatment of neuropathy in PVD are critical for preventing adverse outcomes and improving patient outcomes 5, 4.