Iliac

Peripheral Vascular Disease - Lower Limb Stenosis – Iliac/SFA/BTK Vascular Disease

Definition:

Peripheral artery disease also called peripheral arterial disease is a common circulatory problem in which blood flow to the organs get reduced due to narrowed arteries. As this is most commonly seen in arteries of legs, it is referred to as peripheral artery disease.

When you develop peripheral artery disease (PAD), your extremities, usually your legs do not receive enough blood flow to keep up with the demand. This causes symptoms, most notably leg pain when walking (claudication).

You can often successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet.

Symptoms:

While many people with the peripheral artery disease have mild or no symptoms, some people have leg pain when walking.

Claudication symptoms include muscle pain or cramping in your legs or arms that is triggered by activity such as walking but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf is the most common location of pain.

The severity of claudication varies widely from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity.

Peripheral artery disease symptoms include:

  • Painful cramping in your hip, thigh or calf muscles after certain activities such as walking or climbing stairs.
  • Leg numbness or weakness.
  • Feeling of coldness in your lower leg or foot, especially when compared to the other side.
  • Sores on your toes, feet or legs that will not heal.
  • A change in the colour of your legs.
  • Hair loss or slower hair growth on your feet and legs.
  • Slower growth of your toenails.
  • Shiny skin on your legs.
  • No pulse or a weak pulse in your legs or feet.
  • Erectile dysfunction in men.

If peripheral artery disease progresses, pain may even occur when you are at rest or when you are lying down (ischemic rest pain). It may be intense enough to disrupt sleep.

Causes:

The most common causes of peripheral artery stenosis are:

  • Atherosclerosis: Fatty plaque builds up in the arteries and blocks blood flow to the lower limbs. This occurs mainly in men over 45 years old.

Less common causes may be,

  • Blood vessel inflammation
  • Radiation exposure
  • Limb injury

Risk Factors:

Following people are at high risk of developing PAD and should get themselves evaluated by expert doctors:

  • Smoker
  • Diabetic
  • Obese (a body mass index over 30)
  • High blood pressure
  • High cholesterol
  • Increasing age, especially after reaching 50 years of age.
  • A family history of peripheral artery disease, heart disease or stroke.
  • High levels of homocysteine, a protein component that helps build and maintain tissue.

Complications:

If your peripheral artery disease is caused by a build-up of plaques in your blood vessels, you're also at risk of developing:

Critical limb ischemia: This condition begins as open sores that do not heal, an injury, or an infection of your feet or legs. Critical limb ischemia occurs when such injuries or infections progress and cause tissue death (gangrene), sometimes requiring amputation of the affected limb.

Stroke and heart attack: Atherosclerosis that causes the signs and symptoms of peripheral artery disease is not limited to your legs. Fat deposits also build up in arteries supplying blood to your heart and brain.

Examination:

Some of the tests your doctor may rely on to diagnose peripheral artery disease are:

Physical exam: Your doctor may find signs of PAD during a physical examination, such as a weak or absent pulse below a narrowed area of your artery, whooshing sounds over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb.

Ankle-brachial index (ABI): This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm.

To get a blood pressure reading your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow.

You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.

Ultrasound: Special ultrasound imaging techniques such as Doppler ultrasound can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.

Angiography: By injecting a dye into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor is able to trace the flow of the contrast material using imaging techniques such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerised tomography angiography (CTA).

Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment, finding the narrowed area of a blood vessel and then widening it with a dilating procedure or administering medication to improve blood flow.

Blood tests: A sample of your blood can be used to measure your cholesterol and triglycerides and to check for diabetes.

Treatment:

Treatment for peripheral artery disease should have two major goals:

  • Manage symptoms such as leg pain so that you can resume physical activities.
  • Stop the progression of atherosclerosis throughout your body to reduce the risk of heart attack and stroke.

You may be able to accomplish these goals with lifestyle changes. If you smoke, quitting is the single most important thing you can do to reduce your risk of complications.

If lifestyle changes are not enough, you will need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.

Treatment options include:

  • Medication

    May include medical therapy as follows

    • Cholesterol-lowering medication
    • Blood pressure-lowering medication for high blood pressure
    • Medication to control blood sugar
    • Medication to prevent blood clots
    • Symptom relief medication

  • Endovascular intervention

    In general, percutaneous endovascular intervention with a plain balloon or drug-coated balloon or combination of balloon and stent have had excellent success rates and is of relatively low risk. A thin tube is cannulated from a puncture in your groin. The procedure consists of dilating the blood vessel with a balloon followed by placing the stent that opens up the narrowed blood vessel. The physician may also use drug-coated balloons that bring in the additional benefit of a drug over a plain balloon. Drug-coated balloons have shown better results and long-term patency compared to normal PTA balloons.

  • Surgical Repair

    Your doctor may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around or bypass the blocked or narrowed artery.

  • Thrombolytic Therapy

    If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.
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