Peripheral Vascular Diseases

You are likely aware of the common symptoms associated with cardiovascular disease – shortness of breath, chest pain, fatigue – that make even light exercise nearly impossible and for some, potentially dangerous. But you may not be as familiar with diseases and issues related to other parts of the vascular system – such as the legs. Many vascular conditions of the legs are treated just like cardiovascular disease by your cardiologist, cardiovascular surgeon or vascular surgeon.

Vascular issues in the veins and arteries of the legs can build up over time – another similarity to heart disease. If left untreated, they can result in pain, limited mobility, ulcers, damage to organs, amputation and life-threatening conditions such as infection, gangrene and stroke.

If you are having any of these symptoms, please schedule an appointment today and consult with a vascular specialist:

• Pain in one or both Calves, Thighs, Hips or Ankles, Especially During Exercise, Walking or Climbing
• Dull, Heavy Ache in Legs
• Tiredness in Legs, Even at Rest
• Change in Color in the Legs – bluish or dark red discoloration – and feeling of cold

At WakeMed, our goal is to alleviate pain, improve quality of life, detect vascular disease and treat it BEFORE a serious problem occurs. More often than not, we can successfully treat vascular conditions – often with minimally invasive procedures that make it possible for the patient to go home the same day.

A very common symptom of peripheral artery disease (PAD) in the leg is claudication, which typically presents as pain, cramping or fatigue in the leg with activity. Changes in the color of the skin on the leg and/or ulcers are obvious indicators of more advanced PAD.

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Vascular Conditions of the Legs

Peripheral Artery Disease (PAD)

PAD is the narrowing of arteries in the body. It is most commonly due to atherosclerosis (buildup of fat and cholesterol that turns into plaque on the inside of arteries). PAD in the legs is one of the main vascular conditions that make that walk in the autumn air difficult.

Peripheral Aneurysm

An aneurysm is a bulging of an artery at a weak spot. A peripheral aneurysm (PA) is one that occurs in an artery other than the aorta. 

Peripheral aneurysms in the legs are most common in the popliteal artery, which runs down the back of the lower thigh to the knee, but can also occur in the femoral artery, which is in the groin area. If you have a peripheral aneurysm in one leg, it’s likely you have one in the other. A PA may also be an indicator of aortic aneurysm. Two out of three PA patients do not have any symptoms. Those who do may have an ulcer on a toe, a pulsating lump they can feel and/or pain or fatigue in the legs with or without activity.

Varicose Veins 

Varicose veins can occur when the valves in the veins of the legs become weak or damaged and do not work properly. As a result, blood pools in the veins, creating lumpy, twisted, swollen veins. Family history, pregnancy, injury and obesity are common causes of varicose veins. Many people choose to have their varicose veins treated from an aesthetic standpoint. Intervention may become necessary if pain, blood clots or skin ulcers are present.

Blood Clot (thrombus) 

Blood clots form in the veins when blood flow is compromised.

They usually form due to:

• Prolonged bed rest or lack of movement
• Injury or infection
• Damaged valves in veins
• Pregnancy
• Surgery
• Genetic disorders (deficiency of natural anticoagulant proteins)

Deep Vein Thrombosis (DVT) which is a blood clot in a deep vein of the leg, and pulmonary embolism (a blood clot that breaks free and travels to the lungs) can cause serious complications as well as death.

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Diagnosing Vascular Problems

To diagnose vascular problems, we start with the basics – symptoms, family history, personal health and lifestyle, and a physical exam. A cardiologist may perform a simple test like an ankle brachial index (ABI) screening to compare the blood pressure in the arm with the blood pressure in the legs. The blood pressure in the legs is typically higher than the blood pressure in the arm.

Additional imaging tests also help the vascular specialist pinpoint the location and extent of a vascular issue as well as how to best treat it. After a history and physical exam, I usually check ankle brachial indices and then perform an arterial duplex (ultrasound) of the arteries of the lower extremities to confirm my suspicion of PAD.

Non-Invasive Peripheral Vascular Disease Tests

• Carotid Doppler Ultrasound
• Renal Artery Ultrasound
• Abdominal Aorta Ultrasound
• ABI of the Upper and Lower Extremities with/without Exercise
• Venous Ultrasound of the Upper and Lower Extremities
• Arterial Ultrasound of the Upper and Lower Extremities

Restoring Quality of Life

Several treatment options exist for vascular conditions. Treatment begins with lifestyle changes. Healthy lifestyle changes alone can often make a big difference in the fight against vascular disease. “This means keeping your blood pressure, cholesterol and diabetes under control, improving your diet, exercising and quitting smoking. Medications such as blood thinners may also be prescribed to help maintain blood flow.

A procedure is necessary when arteries become so clogged that blood flow is diminished to the point where oxygen is not reaching the leg muscles. When our legs do not get the oxygen they need, serious problems, such as ulcers, infection and gangrene can occur. If left untreated, these serious conditions can lead to amputation, organ failure and a higher risk of mortality.

Interventional cardiologists & surgeons frequently perform the following procedures to treat Peripheral Vascular Disease:

• Catheter-based procedures to open clogged arteries in the legs, using similar technology and technique as in heart procedures – angioplasty and stents – to open blood vessels in the legs and keep them open. During catheter-based procedures, often, our physicians will employ technologies to help shave off plaque to help minimize the need for stents. While the patient is under mild sedation, the physician inserts a catheter (thin flexible tube) into the blood vessel and threads it to the location of the blockage. Physicians essentially an X-ray camera and computer monitor to help guide a wire past the blockage. This serves as support while we guide an uninflated balloon or other device (such as one that may shave off plaque) across the blockage. We then inflate the balloon or activate the device to open the artery or remove plaque. The physician will then usually place a stent in the artery to keep it open.
• Bypass surgery is another option for blocked blood vessels as well as aneurysms in the legs. Physicians make an incision near the affected area and attach a vein from another part of the body above and below the blockage, therefore bypassing the blockage or aneurysm and restoring blood flow.
• Endovascular Aneurysm Repair (EVAR) - Endovascular techniques to treat peripheral dissections (when the inner wall of an artery tears) and bypass techniques to perform arteriovenous graft surgery (connecting an artery to a vein) to make life-saving hemodialysis treatment for patients with kidney failure possible.

Peripheral Vascular Disease Treatments

• Endovascular Aneurysm Repair (EVAR)
• Catheter Directed Thrombolysis of Pulmonary Embolism
• Complex Peripheral Interventions for critical limb ischemia and deep venous thrombosis (DVT)
• Peripheral Artery Stent
• Peripheral Artery Atherectomy
• Saphenous Vein Ablation
• Peripheral Angiography
• Peripheral Thrombolysis
• Foam Sclerotherapy and Phlebectomy for varicose veins and venous insufficiency
• Abdominal Aortic Aneurysm and Abdominal Peripheral Vascular minimally invasive procedures
• Carotid and Subclavian Artery (neck and arm blood vessel) blockage surgery

PVD Risk Factors Include:

• Increasing Age (normally occurs after age 60)
• Diabetes or Family History of Diabetes
• Smoking
• Overweight
• Family History of Cardiovascular Disease, High Blood Pressure and High Cholesterol
• Sedentary Lifestyle
• Personal History of High Blood Pressure and High Cholesterol