Lower Extremity Arterial Disease
Peripheral arterial disease (PAD) is a narrowing or blockage of the arteries leading to decreased blood flow to your arms and legs. When focused in the legs, this condition is known as lower extremity arterial disease. For more background on how the arteries narrow and tests to diagnose the degree of blockage, see the PAD page on our website. This page concerns arterial disease in the legs, and details the various procedures we use at Nevada Vein and Vascular to open the blockage.
What is lower extremity arterial disease?
People who develop PAD commonly suffer from atherosclerosis, colloquially known as “hardening of the arteries.” This occurs when plaque (fatty material) builds up on the inner walls of the arteries. This narrows and clogs the arteries and decreases blood flow. In the legs, this is known as lower extremity arterial disease and can lead pain and cramping when walking, and later can result in pain in the toes and feet when a person is resting. This is because the arteries are now unable to deliver enough blood to the feet. In its most advanced stage, this can lead into tissue necrosis, even possible amputation.
What are the symptoms of lower extremity arterial disease?
What a patient experiences as blood flow to the legs decreases depends on where the narrowing is occurring. If you feel pain and/or cramping in the hips, thighs, or calves when walking, but this goes away when at rest, this is known as claudication. The reason it occurs when walking is because the leg muscles require more oxygen-rich blood during exercise but can’t get it due to the decreased circulation.
If the atherosclerosis progresses, pain may develop in the toes or feet even when the person is resting. This is known as “rest pain,” and shows the arterial disease is reaching a critical stage.
These are additional sign/symptoms of lower extremity arterial disease:
- Decreased hair growth on the legs and toes
- Paleness of the leg or foot when elevated
- Inability to feeling a pulse in the feet
- Blue/red discoloration of the foot when hanging downward
- Coolness of the leg or foot
- A sore on the foot that does not heal
With these symptoms the patient is in danger of losing possible toes or even a foot. The blockage needs to be addressed. At Nevada Vein & Vascular, we use what are called percutaneous procedures to attack the blockage.
What is a percutaneous procedure?
When attempting to get to the blocked artery or arteries, we use percutaneous procedures. In contrast to “open” procedures, when organs or tissues are exposed directly by surgery, percutaneous methods allow access non-invasively through a needle puncture of the skin and artery and the insertion of a catheter.
What types of percutaneous procedures are used to address lower extremity arterial disease?
Angioplasty and Stenting
When the patient has short areas of blood vessel narrowing, we may perform an angioplasty on the narrowed portion of the artery. In this procedure, after a needle is used to gain access to the artery, a wire is inserted and then a balloon catheter along the wire. Using ultrasound guidance, the catheter is then pushed forward into the narrowed area of the artery. The balloon is then inflated, and this pressure pushes the plaque against the inner wall of the artery, opening the artery for blood flow. In most cases, a stent, a tubular support, is left in place to keep the artery dilated. With minor buildup, stenting may not be necessary.
An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from the leg artery. It’s important to not only break up the plaque, but to also remove it so that it doesn’t lodge somewhere else. To do this the catheter is designed to collect the removed plaque in a chamber on the tip, so when the catheter is removed along with it goes the removed plaque. An atherectomy is especially useful for treating blockages in arteries that occur around branches or in vessels that are not easily treated with stents.
What other options are there?
For patients who are not good candidates for angioplasty or atherectomy, or who have already failed a prior angioplasty attempt, lower extremity bypass surgery can be highly effective. Unlike the above procedures, this is open surgery through incisions in the leg.
A surgical bypass reroutes blood flow around a blocked vessel by creating a new pathway for the blood. In this surgery, we either use a vein from another spot in the patient’s legs or a synthetic graft to detour the blood flow around the blocked areas of the artery. The bypass is sewn into the artery above the blockage and back to the artery below the blockage. After the surgery, the blood flows through the artery, but then into the bypass before reentering the artery past the blockage.