What is the treatment for PVD?
The 2 most important treatments for PVD are aggressive risk factor modification and a daily walking program. It is extremely important that the previously mentioned risk factors be controlled to prevent these blockages from becoming worse over time. The most effective steps that patients can take to modify these risk factors are to stop cigarette smoking and lower their cholesterol, diabetes, and blood pressures to normal recommended levels.
Walking is very important to help maintain muscle tone, lower body weight, and develop better circulation to the feet. Patients should try and achieve a goal of walking 30 minutes a day, at least 5 days a week. There is a medication,called Pletal®, that has been approved by the US Food and Drug Administration (FDA), and can help improve blood flow to the feet. Pletal has been shown to increase the distance patients can walk before they develop claudication. For mild claudication, it is a very effective medication. It does not by itself, however, "dissolve" the blockages that are in the arteries, and patients with moderate-to-severe claudication frequently require procedures to open blocked arteries.
What types of procedures can be performed to open blocked arteries in the legs?
Similar to the heart, arteries in the legs can be opened by using catheters with balloons and stents or by surgery to bypass the blocked vessel. Patients typically prefer balloons and stents because this approach is less invasive. This is called a percutaneous procedure, in contrast to the surgical procedure that requires a bypass. Percutaneous procedures significantly shorten recovery time with less discomfort, and the long-term outcome results are as good or better than surgery. Therefore, the first-line approach to opening blocked blood vessels in the legs should be with a balloon or stent if the blockage is amenable to this kind of therapy. If the artery cannot be successfully opened percutaneously, then surgery is an alternative.
What risks are possible with angioplasty to the legs?
Although angioplasty and stents are preferred to surgery, these procedures are not without risks. Major complications can happen, although infrequently. The following is a list of the most important serious complications:
Death (0.1%)
Major bleeding (2-3%)
Limb loss, particularly in patients with advanced lack of blood supply to the legs (1%)
Kidney failure (1-10%), especially in the patient with heart failure, preexisting kidney disease, and diabetes
Early closure of the artery after a successful treatment that will require subsequent treatments
Damage to the blood vessels and nerves at the puncture site (typically in the groin)
Infections, strokes, and heart attacks to a lesser extent
What risks are possible with surgery to the legs?
Surgery to the legs can carry all of the above risks in addition to a longer recovery phase from generally bigger wounds.
What is an aneurysm?
An aneurysm is a "weakened" area of an artery that is bulging out in the same way that a garden hose may develop a bulge at a weak spot. The danger in aneurysms is if they become large enough, they can spontaneously rupture. Aneurysms can occur throughout the body but most commonly occur in the main aorta that runs down through the chest and abdomen. If an aortic aneurysm were to rupture, this could be a life-threatening event. Therefore, aneurysms are typically repaired with surgery or, more recently, with less invasive stent grafting prior to rupture.
Unfortunately, many times aneurysms do not have any symptoms until they begin to rupture. If your doctor suspects the presence of an aneurysm on examination, further testing can be ordered to evaluate the presence of an aneurysm in you. Screening for aortic aneurysms can be done using an abdominal ultrasound or CT scan.
Why do my legs swell?
Leg swelling, or edema, can be caused by a number of reasons. Some of these problems may be quite serious, while others are rather benign and cosmetic. Swelling in both legs may represent a heart or kidney problem, or a more benign problem is incompetent valves in the veins of the legs (varicose veins). Swelling in 1 leg may represent a blood clot in that leg or a blockage in the lymph nodes in the groin. It is also common for a leg to swell after veins have been removed for coronary artery bypass grafting. Any new swelling of 1 or both legs should be evaluated by your primary care physician.
What is abdominal angina?
Abdominal angina is pain in the abdomen resulting from blockages to the main arteries that supply the guts. It typically presents itself with pain in the abdomen after eating that cannot be explained by gastrointestinal pathology, such as gallbladder disease or ulcers or inflammatory diseases. Blockages in those arteries, called the celiac arteries or mesenteric arteries, can lead to a reduction in the blood supply needed for digestion and transport of food to the body from the guts.
Patients typically experience predictable pain in the abdomen with food and weight loss. Cholesterol plaques cause a narrowing in these arteries similar to blockages in the neck, heart, and legs. Treatment of these blockages can be done with either surgery or with angioplasty and stents. The diagnosis is best made by a CT angiogram or a conventional angiogram in the catheterization laboratory.
Generally, treatment of these blockages can lead to resolution of symptoms almost immediately after the procedure.
Summary: ways we can reduce the risks or impact of PVD
Quit smoking
Walk at least 30 minutes 5 times per week
Maintain an appropriate body weight
Reduce blood pressure and cholesterol
Aggressively manage your diabetes with the help of your doctor and dietitian
Seek medical attention promptly if experiencing foot pain at night along with discomfort in the calves when walking a short distance.
