Peripheral Vascular Disease

Peripheral vascular disease is caused by atherosclerosis which causes a build-up of plaque inside the arteries that decreases the blood flow of oxygen and nutrients to the muscles and tissues of the legs and feet (this is called ischemia).
SIGNS AND SYMPTOMS

The signs and symptoms of peripheral vascular disease may include:

  1. Intermittant Claudication – cramping pain in the muscles of the buttocks and/or legs that occurs with walking and exercise, and decreases with rest.
  2. Rest Pain – as arterial disease progresses, pain occurs at rest, often located on the top of the foot and across the toes. Pain is worse when feet/legs are elevated; pain decreases when the legs are lowered, as blood flow increases to the foot.
  3. Tissue Breakdown and Gangrene – as arterial disease progresses further, the skin begins to breakdown and ulcers can develop. When tissues are unable to get the circulation needed for growth and repair, gangrene (death of the tissue) can occur.
  4. Other possible signs and symptoms of peripheral vascular disease include: --decreased hair growth on feet/legs --absence of pulses --paleness of the leg or foot when elevated --coolness of the foot/leg --discoloration of the foot/leg when hanging down --numbness or tingling --decreased ability to spread toes and move feet.

TREATMENT

The treatment for peripheral arterial disease includes exercise therapy, risk factor modification, medication or surgery.

  1. Exercise Therapy – an exercise program, including walking, can help to train the muscles of the legs to work with reduced blood flow and can increase collateral blood flow. This can help to decrease leg pain and increase the ability to ambulate more comfortably.
  2. Control or Reduce Risk Factors – smoking cessation, control of cholesterol and triglycerides, high blood pressure and, for diabetics, controlling blood sugar. The modification of risk factors can slow the progression of atherosclerosis and decrease the symptoms of vascular disease.
  3. Medications – there are several medications that can be used to “improve” circulation. They act by helping the blood move through the arteries more easily. Some of these medications are aspirin, Plavix, Pletal and Aggrenox. The correct combination of medicines is based upon the nature of your disease and other medical conditions.
  4. Surgery – surgery is indicated for patients who have severe peripheral vascular disease which is causing severe limitation of lifestyle or occupational activity. In the presence of rest pain, a non-healing ulcer or gangrene of the toes or foot, surgical intervention is usually necessary to restore and/or maintain the viability of the limb.

TYPES OF INTERVENTIONS AND SURGERY

  1. Balloon Angioplasty – this procedure may be used for short areas of blood vessel narrowing. A small tube, or catheter, with a balloon at the end of it, is placed in the artery at the area of narrowing. This balloon is then deflated and the catheter is removed. Contrast material is injected and X-rays are taken to determine if the artery has opened adequately. If not, the procedure is repeated. Occasionally, a small stent (wire support or “bird cage”) is inserted into the artery to keep the area open.
  2. Thrombolytic Therapy – in this procedure, special medication is given through a catheter into the blood vessel to dissolve blood clots. The medication may be given for several hours to a few days to dissolve the clot. X-rays are taken regularly to see if the clot is dissolving.
  3. Atherectomy – a small catheter with a cutting blade is introduced into an artery. The blade cuts into the plaque at a high speed and small pieces of the plaque are removed. This procedure can be done using injection of contrast, with a balloon angioplasty or during surgery.
  4. Endarterectomy – this surgery involves opening the diseased artery, removing the plaque and closing the artery with sutures. This may be done alone or with other procedures at the same time.
  5. Bypass – this is a surgical procedure where the obstruction in the artery is bypassed. A patient’s own vein or a graft made from synthetic material may be used. The graft is attached from above the blockage to below the blockage, thus restoring good blood flow to the limb.

Each of these methods of treatment has its own advantages and disadvantages; therefore, it is important to understand that the same therapy is not best for all patients. Your doctor and the vascular team will determine which of the above treatments is best for you and will discuss this with you. Feel free to ask questions regarding any of these treatment alternatives.