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. |
