Peripheral Artery Disease

What is peripheral arterial disease?

Atherosclerosis, also known as “hardening of the arteries”, is a disease in which fat, cholesterol and calcium (plaque) build up inside the vessels that transport blood around the body (arteries). Over time plaque hardens causing narrowing of the vessels and limits the flow of blood. Vessels severely affected can become completely blocked. When it affects the peripheral arteries in the legs it can cause problems walking, pain in the legs and feet, ulcers and in advanced cases gangrene. Patients with peripheral arterial disease are also at risk of heart and carotid disease.

What causes peripheral arterial disease?

Some things that cannot be changed, such as male gender and advanced age, are associated with peripheral arterial disease. Modifiable risk factors that can be addressed include being overweight, high blood pressure, high cholesterol and high blood sugar in patients with diabetes. Smoking is also a risk factor and patients should carefully consider the benefits of quitting, especially if they require procedures to help restore the blood supply to the legs as these are much less likely to work in active smokers, seek advice from your GP.

How do I know if I have peripheral arterial disease?

Identifying patients with blocked arteries in the legs can be done by measuring the blood pressure at the level of the ankles and comparing it to the blood pressure in the arm (ankle-brachial pressure index). This test has limitations especially in patients with heavily diseased arteries and with diabetes. More detailed information can be obtained with an ultrasound scan. Ultrasound is a non-invasive test that uses high frequency sound waves to obtain images or extent of the disease .It is not painful and does not require any injection or radiation and performed by an experienced vascular sonographer.

What problems can peripheral arterial disease cause?

Pain in the leg muscles that occurs when walking and is relived with rest (intermittent claudication) is a common problem in patients with peripheral arterial disease. This can be especially problematic when walking uphill and for some patients can significantly limit their mobility. In more advanced cases patients can experience pain when resting and particularly at night, ulcers and gangrene. If not appropriately treated to restore blood flow to the leg, a proportion of patients will go onto require amputation of the leg. Patients with uncontrolled diabetes, those on dialysis and active smokers are at highest risk. Early identification of patients at risk is essential to avoid these devastating complications.

How can peripheral arterial disease be treated?

The most important thing is to address the causes of peripheral arterial disease outlined above. Simple measures such as losing weight through diet and exercise are important. Patients with intermittent claudication should continue to walk regularly and need to understand that although they will still continue to experience pain, damage is not being done to the leg. Patients should also discuss with their GP the potential benefits of being on aspirin to thin the blood and reduce the risk of blood clots. Patients should also consider being investigated for heart and carotid disease as the causes of peripheral arterial disease and heart and carotid disease are the same.

What are the options for more severe peripheral arterial disease?

Intervention for peripheral arterial disease has traditionally involved open vascular surgery, such as endarterectomy to clean out the artery directly or bypass to restore flow beyond the blockage. However, more recently the development of minimally invasive keyhole surgery (endovascular surgery) through the groin allows for restoration of flow through angioplasty, where balloons are used to open the arteries, and stenting (inserting a scaffold), where a scaffold is used to hold arteries open. A patients’ suitability for open vascular surgery or endovascular surgery depends on a detailed examination of the arteries using angiography where dye is used to image the arteries.

What are the risks associated with vascular surgery?

Open vascular surgical operations are major procedures. Careful consideration needs to be given in relation to the risks versus the benefits. There can be complications such as infection, failed grafts, development of blood clots or heart and lung problems. Complications are more likely to occur ally in patients who continue to smoke.

Minimally invasive endovascular surgery has fewer risks, but complications can occur including damage to the groin arteries accessed during the procedure and kidney damage from the dye used to image the arteries. Dr Freeman has extensive experience in managing patients with peripheral arterial disease and can advise whether you are best treated non-operatively, with surgery or with endovascular treatment.

Sydney Vascular Ultrasound provides specialised vascular and venous diagnostic imaging in Burwood, Bankstown and Liverpool.