Lower Extremity Arterial Disease
What Is Peripheral Arterial Disease (Pad)?
Peripheral arterial disease (PAD) is a narrowing or blockage of the arteries leading to a decrease in blood flow to your arms and legs. When focused in the legs, this condition is known as Lower Extremity Arterial Disease. This page concerns arterial disease in the legs, and details the various procedures we use at Nevada Vein and Vascular to open the blockage.
Who Gets Pad?
Certain conditions and habits increase the chances of developing PAD. We call these risk factors. The most common risk factors include:
- Heart disease, such as coronary artery disease (CAD)
- Being age 50 or older
- High blood pressure and cholesterol
PAD can sometimes be controlled with lifestyle changes alone. These changes include quitting smoking, exercising daily, and managing health problems such as diabetes. Medications may also help. Your doctor is likely to ask you to try these measures first. If they don’t lessen PAD symptoms, surgery or other procedures may help improve your quality of life.
Both Doctors Dixon and Albright are extremely concerned about their patients! Mom is headed to bypass surgery on her leg next Thursday. I am confident that she is going to get the best care she could possibly get!!! And I am extremely grateful for that!!!
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.
Additional signs/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.
How Does Blood Circulate In The Body?
With each beat, your heart pumps oxygen-rich blood throughout the body. Arteries carry this blood to your organs and muscles. Veins then return oxygen-poor blood to the heart. If an artery is damaged, blood flow may be slowed down or blocked. This means your organs and muscles don’t get all the oxygen they need.
Blood leaves the heart through the aorta, the body’s main blood vessel. From there, it flows into large arteries in the abdomen and thighs. These branch into smaller vessels in the legs and feet.
An artery is a muscular tube. It has a smooth lining and flexible walls that allow blood to flow freely. Active muscles need increased blood flow and oxygen. Healthy arteries can meet this need.
Types Of Artery Problems
Arteries become stiffer and thicker with age. Artery linings can be damaged by smoking, high cholesterol, diabetes, and other factors. This allows plaque (a buildup of fat and other materials) to form within the artery walls. The plaque narrows the space inside the artery and can limit blood flow. Some other problems may include:
- Damaged Artery – PAD begins when the lining of an artery is damaged. Plaque then starts to form within the artery wall. At this stage, blood still flows normally, so you’re not likely to have symptoms.
- Narrowed Artery – If plaque continues to build up, the space inside the artery narrows. The artery walls become less able to expand. The artery still provides enough blood and oxygen to your muscles during rest. But when you’re active, the increased demand for blood can’t be met. As a result, your leg may cramp or ache when you walk.
- Blocked Artery – An artery can become blocked by plaque or a blood clot. This prevents oxygen from reaching muscle below the blockage. Then, you may feel pain when lying down. In time, the affected tissue can die. This can lead to the loss of a toe or a foot.
Tests To Measure Blood Flow
You may have tests that check the blood flow in your legs and feet. These tests are quick and painless.
- Ankle-brachial index (ABI) compares blood pressure in your ankle with pressure in your arm.
- Doppler ultrasound looks at the blood flowing through your arteries. It can show changes in blood flow due to artery narrowing or blockage.
Other tests can show the amount of narrowing or blockage in an artery and its location. Your doctor will use the results to recommend a plan for treatment.
Types Of Imaging Tests
Other tests can show the amount and detect the narrowing or blockage in an artery and its location. Contract fluid allows the condition of the arteries to show more clearly. Your doctor will use the results to recommend a plan for treatment.
- Arteriography – In this test, x-rays help locate the narrowing or blockage in the artery. We offer the patient medication to help keep them comfortable and pain-free. Then, a long, thin tube (catheter) is inserted into an artery, usually in your groin. It is carefully threaded to the affected artery. When the catheter is in place, a contrast fluid is injected into the artery. This makes the blood flow show up clearly on x-rays. Several images (arteriograms) are taken. A procedure to treat the artery problem may be done right after arteriography. During your examination, our team will discuss this with you in advance.
- CT Arteriography – CT arteriography uses computer-generated x-rays to provide detailed images of arteries.
- MR Arteriography – MR arteriography uses a strong magnet and radio waves to produce images of blood flow in the arteries.
Risks & Complications Of Arteriography
Although complications of arteriography are fairly rare, risks may include:
- Bleeding, bruising, infection, or pain at the catheter site
- An allergic reaction to the contract fluid
- Blood clots
- Artery damage
- Kidney problems
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.
percutaneous Procedures for lower extremity arterial disease
- Angioplasty and stenting
Angioplasty and Stenting
When a 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.
The Atherectomy Procedure
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.