Peripheral Vascular Disease
Peripheral vascular disease refers to blockages in arteries of the brain, kidneys, and legs. Peripheral vascular disease is a form of atherosclerosis, also known as hardening of the arteries, and is a progressive disease process.
Atherosclerosis is caused when fatty substances build up inside the artery walls over time and create a narrowed opening which restricts proper blood flow. This build up is most likely to occur in the iliac arteries (lower abdomen leading to the legs), the femoral and popliteal arteries (legs), the renal arteries (kidneys) and the carotid arteries (in the neck leading to the brain).
When organs and muscles in the body receive an insufficient supply of oxygen-rich blood, they literally become starved and alert you to this fact by producing pain. If the blockage occurs in the arteries supplying the legs, the resulting symptom is a cramping pain in the hips, thighs or calf muscle and can limit even casual walking. If the cycle of pain is relieved with rest, we call the condition intermittent claudication. Pain that occurs during rest can sometimes be alleviated by lowering the legs so the force of gravity shunts blood into the feet. If blood circulation becomes so severely restricted that the legs and feet are perpetually starved for nutrition, gangrene--or death of the tissue-- can occur. Without treatment, the entire foot or possibly part of the leg may have to be amputated.
Other symptoms of peripheral vascular disease in the lower extremity include: coldness of the leg and foot; paleness of the leg or foot if elevated; blue/red discoloration of the foot or toes; loss or decreased growth of hair on the legs; dry, fragile or shiny-looking skin; numbness, tingling or pain in the leg, foot or toes; sores that do not heal.
Other conditions can also cause these symptoms. Therefore, a thorough examination with a physician is necessary. Symptoms of peripheral vascular disease in the carotid arteries include: sudden, temporary weakness or numbness of the face, arm and/or leg on one side of the body; temporary loss of speech or trouble speaking or understanding speech; temporary dimness or loss of vision, particularly in one eye; unexplained dizziness, unsteadiness or sudden falls. Transient Ischemic Attacks (TIA'S) are mini-strokes and illicit the same symptoms named above except they are temporary. At this time, carotid atherosclerosis can only by corrected by surgery.
Symptoms of peripheral vascular disease in the renal arteries include; hypertension (high blood pressure-consistently higher than 140/90); abnormal kidney function blood tests.
When any of the above-named symptoms occur, a history and physical examination accompanied by an ultrasound Doppler test are initially performed. The ultrasound Doppler test visualizes the inside of the arteries using sound waves to determine if there is plaque buildup, and if so, to what extent. This test is simple and painless.
If the test shows that the stenosis (or narrowing of the artery) is severe, then a test called an arteriogram or aortagram will give your physician the complete information he or she needs to properly diagnosis your condition.
During the procedure your physician will insert a long, thin tube into a blood vessel in your groin or arm. The tube will be gently directed to the level of your belly button. A contrast dye is then injected into your legs while x-ray pictures are taken.
This procedure can be performed on an outpatient basis at the JFK Medical Center Heart & Vascular Institute. In preparation for your test, blood work will be ordered one to two days before the scheduled date. The day of the procedure, you will be asked to arrive early to the lab and someone should be able to drive you home. About one hour before the procedure, an intravenous line will be started. Once the procedure is complete, the catheter tube will be removed and firm pressure will be applied to the entry site for approximately thirty minutes; also a large, tight pressure dressing will be applied. You will return to your room or recovery area where you will need to lie flat in bed for three to four hours.
When the dressing is removed, you will notice a small bruise at the catheter insertion site, no larger than the size of a quarter. You may also feel a hard lump. It is normal to expect the bruise to become slightly larger and darker the first few days you are home. They are the result of the body's normal healing process and should completely disappear in about two weeks. If you become uncomfortable or are experiencing any discomfort, please call our office immediately.
Many treatments can be used to improve blood flow through the arteries. The latest interventions for treating vascular disease can bring swift relief and more cost effective than surgery. Most procedures require no more than an overnight hospital stay. Patients enjoy an early return to most normal activities. Devices now available include balloon catheters, stents, atherectomy and lasers. All these alternatives treat the build-up of plaque by removing it, compressing it or displacing it. During these procedures the physician will periodically inject a contrast dye and take x-ray pictures to determine whether or not the artery is sufficiently opened. If the blockage is extremely long or has become very hard and calcified with time, it may be resistant to any of these interventions. In these cases, surgery may be required to bypass the problem area.
What to Expect
Preparation for the interventional procedures is similar to the diagnostic aortagram. Usually patients are admitted to the hospital in the morning for all the pre-procedure testing with the procedure itself being performed later the same day. Discharge from the hospital usually occurs the following morning.
Balloon Angioplasty is now the most common method used for opening an obstructed artery. A thin floppy wire is first passed through the narrowed opening in the artery. A deflated balloon is passed along the wire to the obstructed area. The balloon is inflated and deflated, sometimes more than once, often in more than one location. This compresses the plaque against the inside of the artery wall and increases the size of the opening. Balloon angioplasty may be used alone to treat the affected area, or can be used in combination with the other therapies.
If an artery that has been opened should happen to close or re-narrow during the procedure, a device called a Stent may be inserted to hold the vessel open. It is a small, metal expandable lattice-shaped tube that mounts onto a deflated balloon. When the catheter has positioned the balloon at the blockage site, the balloon is inflated and the stent expands. The balloon and catheter are removed, leaving the stent in place to keep the artery open.
An atherectomy catheter has a small rotating cutter at its tip that shaves and removes plaque from the artery. Once the plaque is removed, the artery is sufficiently open to restore improved blood flow.
After the Procedure
A nurse will monitor your vital signs and frequently check the pulse in your groin area, behind your knees and at your ankles and feet. You will lie flat in bed for a few hours before the doctor allows you to get up and move around again.
Upon your discharge, you will be given instructions about medications which will help keep the arteries open, diet counseling and an exercise prescription.