End stage peripheral vascular disease (PVD) presents a higher risk of serious complications, such as gangrene or a heart attack. Treatment with surgery is usually necessary, and severe cases may require amputation.

End stage PVD is severely reduced blood flow to parts of your body other than your heart or brain. Doctors classify reduced blood flow to these areas separately.

Around 40–45 million people in the United States have PVD. Individuals with end stage PVD may develop ulcers or gangrene requiring surgical treatment or amputation to prevent severe complications.

The most common cause of PVD is atherosclerosis. This is a buildup of plaque inside your blood vessels over many years. Lifestyle habits such as a lack of exercise and a diet high in foods containing unhealthy fats contribute to this plaque buildup.

In this article, we examine end stage PVD in more detail, including its symptoms, causes, and risk factors.

The most common cause of end stage PVD is atherosclerosis. This condition doesn’t typically cause symptoms until it progresses to the intermediate stages and leads to intermittent claudication.

Intermittent claudication is an aching pain that usually develops in your calf, thigh, or buttocks due to a lack of blood flow to your muscles. In the beginning, it usually only develops after extended walking or exercise. As PVD progresses, however, the pain may be present even at rest.

People with end stage PVD also develop ulcers or gangrene, most commonly on their feet and legs. In addition, they may have symptoms such as:

Acute vs. chronic limb ischemia

Having ischemia means that one of your tissues or organs isn’t receiving adequate blood flow. Limb ischemia is a hallmark symptom of end stage PVD.

Acute limb ischemia develops quickly due to a sudden obstruction in a blood vessel. Most cases are due to blood clots in people with preexisting PVD or those who have recently had surgery. They can also occur due to trauma or compression of a blood vessel.

Chronic limb ischemia develops slowly over time from a severe blockage of an artery. The most common cause is atherosclerosis.

Symptoms by stage

The two most common staging systems for PVD — Fontaine and Rutherford — are based on the development of ulcers, gangrene, or intermittent claudication.

StageFontaine systemRutherford system
0no symptoms
1no symptoms or minor symptoms, such as cold extremitiesmild intermittent claudication
22A: intermittent claudication after more than 200 m of walking

2B: intermittent claudication after less than 200 m of walking
moderate intermittent claudication
3pain at rest, especially while lying down for sleepsevere intermittent claudication
4ulcers or gangrenepain at rest
5ulcers of the toes
6severe ulcers or gangrene

End stage PVD often requires treatment with endovascular surgery. This involves a healthcare professional (HCP) using a long, thin tube to access the inside of your blood vessels.

The first-line treatment is usually percutaneous transluminal angioplasty. This procedure involves an HCP inserting a small balloon into your blood vessel to unblock an artery.

People with end stage disease are more likely to require amputation if they develop gangrene.

End stage PVD can be life threatening. Potential complications include:

People with chronic limb ischemia have about a 15–20% chance of needing an amputation within a year and about a 50% chance of dying within 5 years, according to a 2019 research review.

In a 2022 study from Singapore, researchers found that nearly half of the 86 people with Rutherford stage 6 disease who had endovascular surgery as treatment needed another surgery within 6 months. The 12-month death rate was 33.7%, and the 12-month amputation-free survival rate was 49.4%.

People with end stage PVD also tend to have other problems that can cause serious complications. These conditions include:

You can prevent the development or slow progression of PVD by taking steps to minimize atherosclerosis. According to the National Heart, Lung, and Blood Institute, you can prevent atherosclerosis by:

  • getting 30 minutes of physical activity per day
  • eating meals that are low in sodium or unhealthy fats
  • taking your medications as your doctor prescribed them
  • sleeping for at least 7–8 hours per night
  • incorporating stress relief techniques into your life, such as:
    • yoga
    • quiet reading time
    • meditation
  • trying to reach or maintain a moderate weight

Here are some frequently asked questions people have about end stage PVD.

How painful is peripheral vascular disease?

One of the most characteristic symptoms of PVD is an aching pain in your legs. In the early stages, this pain may only bother you when you’re walking. But you may feel it all the time as your condition progresses.

Can you live a long life with peripheral vascular disease?

You may be able to stabilize or even potentially reverse PVD by making lifestyle changes and taking medications to control your blood pressure and cholesterol levels. People with end stage disease often have worse outlooks since they frequently have many other health issues.

Can peripheral vascular disease cause sudden death?

PVD can lead to complications that can cause sudden death, such as a heart attack or stroke.

End stage PVD can be life threatening. People with end stage PVD have ulcers or gangrene on their feet or lower limbs, which may require amputation as a result.

Making lifestyle changes such as avoiding unhealthy fats and exercising regularly can help prevent end stage PVD. Your doctor may also recommend taking medications to combat high cholesterol or high blood pressure, which might contribute to plaque buildup in your blood vessels.