Peripheral Artery Disease


What is peripheral artery disease?
Peripheral artery disease, also known as arterial obstruction, occurs when fatty clumps called “plaques” build up inside the arteries that take blood to the legs. When plaque forms in these arteries, they become narrow or completely obstructed. This prevents blood from flowing normally. When muscles do not get enough blood, pain can occur. This pain is located in the calf of thigh, and starts when a person walks and stops when he or she ceases to walk. Doctors call this kind of pain “claudication”.

Some people have a greater chance of getting peripheral artery disease, such as those who:
 
  • Smoke
  • Have diabetes
  • Have high cholesterol
  • Have high blood pressure


What are the symptoms of peripheral artery disease?
Peripheral artery disease often causes pain in the calf of thigh, that starts when a person walks and stops when he or she ceases to walk. In severe cases, it can also cause:
 
  • Trouble getting an erection (in men)
  • Cold feet with purple color
  • Wounds in the feet, that do not heal
  • Leg pain, that occurs during rest

Symptoms of peripheral artery disease can vary from one person to other, depending on:
 
  • Which arteries are affected
  • How narrow the arteries are
  • How much activity a person does

Is there a test for peripheral artery disease?
Yes. The vascular surgeon can diagnose peripheral artery disease through careful leg examination.  He can also measure the ankle pressure with a ultrasound doppler device. In some cases, he may need to ask for imaging exams:
 
  • Duplex ultrasound – visualizes arteries and gives the percentage of narrowing.
     
  • Magnetic resonance imaging – uses a magnet to visualize arteries and estimate the percentage of narrowing. It requires an injection of a chemical in the arm vein, that makes the vessels show up more clearly.
     
  • Computed tomography – uses X-ray to visualize arteries and estimate the percentage of narrowing. Also requires an injection of a chemical in the arm vein.
     
  • Angiography - uses X-ray and a chemical injected directly in the arteries.


What is the treatment of peripheral artery disease?
Treatment of peripheral artery disease must start with:
 
  • Stop smoking
  • Get diabetes, high blood pressure, and high cholesterol under control 
  • Exercise – vascular surgeons can tell which is the appropriate type of exercise for each case.


Are there other available treatments?
Along with exercise and getting medical conditions under control, people are treated with medicines to increase blood flow to the legs. 

If the symptoms cannot be controlled with medicines, or severe symptoms appear, such as wounds and rest pain, vascular surgeons can perform the following procedures: 
 
  • Angioplasty and stenting – the vascular surgeon will use a small needle to put a wire into a blood vessel in the groin area. For angioplasty, he threads a deflated balloon over the wire to the narrowed or blocked area. Once there, he inflates the balloon. This opens the blood vessel. The balloon is then deflated and removed. A stent is a wire mesh tube that stays in the body. It is used to keep the opened vessel from closing again.
     
  • Surgery – the vascular surgeon can do surgery, called “bypass,” that creates a way for blood to flow around the blocked artery. During bypass, a doctor sews a tube called a “graft” around the blocked artery. A graft can be a vein from another part of the body, or it can be manmade.


Which is the best procedure?
The best procedure depends on each case. Angioplasty and stenting works very well when a small and localized portion of the artery is obstructed. For large obstructions, or for severe disease, surgery is a better option. Vascular surgeons can recommend the best procedure for each case. If he suggests angioplasty and stenting or surgery, it is important to ask these questions: 
 
  • What are the benefits of each procedure for me?
  • What are the downsides of each procedure for me?
  • What happens if I do not have any procedure?
  • Does the surgeon who will do the procedure have experience?

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