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Essam El-Kady, chief of Vascular Surgery at the El Maadi Armed Forces Hospital in Cairo, Egypt operating with Dr. Brantigan. Click to enlarge.

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Arterial Disease of the Legs 

The heart pumps blood through vessels called arteries. The first and largest artery is the aorta. It starts at the level of the heart and extends downward in the chest and abdomen to the belly button. This large artery divides and travels into each leg. Although you will hear many names for arteries, these are all connected and the names change mostly to identify the location. Think of them as a system of connecting tubes that allows free flow of blood from the heart to the farthest part of the body, toes and fingers and all organs.

As we described in the introduction to arterial disease, a fatty substance called plaque can build up along the inside wall and cause narrowing of the artery. When the narrowing in arteries to the leg is severe, blood flow is reduced to the muscles beyond the plaque. There are many levels where plaque can narrow these arteries. The symptoms vary according to the site of plaque deposit and the severity of the narrowing. Plaque can be isolated to one area or be present at multiple locations.

Symptoms

  • Leg pain or cramping in the buttock, thigh or calf with walking. These are relieved by resting (called claudication /claw-dee-k-tion/).
  • Severe pain of the foot especially at night (called rest pain). This pain may be relieved by hanging your leg over the side of the bed, or sleeping.
  • Your legs hurt when they are elevated.
  • Nonhealing wounds of the toes, foot or lower leg.

Diagnosis

1. A complete examination by a vascular specialist.

2. Simple, painless testing using blood pressure measurements on legs & arms.

3. Arteriogram - This is ordered if the previous test demonstrates a need for surgery to correct poor blood flow to the leg.

Treatment

Medical Management

If a patient's only symptom is pain in the leg, usually in the calf with walking, the treatment may be as simple as an exercise program. The goal is to increase the distance one can walk before pain in the muscle develops. This can be very effective for a specific set of people. It requires motivation and commitment. Occasionally, a patient will benefit from certain medications.

Surgical Management

Arterial bypass grafts: An arterial bypass requires surgical intervention to detour blood around a blockage in the artery. This is created using a patient's own vein or synthetic material (tubing). Remembering that blood must flow from the large aorta, arising in the heart, all the way to the feet, will help you understand that bypasses to restore blood flow (circulation) could be in the abdomen, in the thigh, from thigh to foot or from the calf to the foot.

Surgery lasts 4 to 8 hours.

The incision location depends on what segment of artery must be bypassed.

Hospital stay is usually 4 to 7 days.

*When a bypass is done, because of non-healing wounds, the stay is going to be extended for wound treatment.

Balloon Angioplasty: A flexible wire is inserted thru the blockage and a high pressure balloon is inflated opening the blockage, sometimes a stent, or a metal strut, is inserted to keep the artery open. Surgery lasts two hours, there is no incision and the patient usually goes home the next day.


2003-2004 Dr. Charles Brantigan,  Vascular Surgery Practice
2253 Downing Street, Denver, CO 80205
303.830.8822 fax: 303.830.7068 or 800.992.4676  inquiries@drbrantigan.com

Last Updated: 07/15/2004