Vascular disease is a process where plaque accumulates in arteries throughout the body. Plaque is comprised of cholesterol, calcium and fibrous tissue that builds up over time and progressively blocks the artery. When this process occurs in the arteries of the leg, symptoms develop. These symptoms can range to cramping in the calf muscles when walking to wounds on the leg which fail to heal. Sometimes there are no symptoms at all.
Peripheral arterial disease is diagnosed through a series of tests starting with a blood pressure of your legs and compared to the pressure in your arm called an ankle-brachial index. Based on these initial findings, a vascular specialist can then recommend additional studies including ultrasound examination of the artery and/or arteriogram.
There are well established risk factors that have been studied which are directly linked to developing peripheral arterial disease. These include smoking, hypertension, high cholesterol and diabetes. It is important to optimize these risk factors in order to achieve good results from any intervention.
Interventions for peripheral arterial disease are dependent on the extent of disease identified. Understanding the process involved and optimizing the risk factors involved are key. In order to get good long-term results, lifestyle changes will need to be addressed including smoking cessation and an exercise regimen.
If the clinical situation is appropriate, an arteriogram can accurately identify the problem and potentially fix the problem during the same procedure. Endovascular intervention (catheters, wires, stents, etc.) has improved the way the disease is approached and can address many issues through a simple puncture in the groin. However, not all situations can be addressed with an endovascular option and traditional surgery may be necessary to improve the blood flow.
Vascular surgeons are uniquely trained to deliver the full spectrum of care for peripheral vascular disease.
Dr. Keith Menes is a vascular surgeon with KentuckyOne Health Surgery Associates in Lexington.