What is Peripheral Vascular Disease?
Peripheral Vascular Disease (PVD) causes a reduction in the circulation to the legs. In most cases, this is due to atherosclerosis (hardening of the arteries), which involves a build-up of fatty plaque in the wall of the artery. This results in a narrowing (stenosis) or blockage (occlusion) to the artery, thereby reducing the arterial supply to the legs.
What are the symptoms?
Symptoms vary depending on the severity of the disease. In its mildest form, there may be no symptoms.
Pain in the legs when walking (referred to as intermittent claudication) is a symptom of Peripheral Vascular Disease (PVD). It is usually felt in the belly of the muscle (calf, thigh or buttocks), comes on with walking and is relieved with rest. As the disease advances, the walking distance shortens.
Further reduction in circulation can result in pain at rest (referred to as “rest pain”). This results in severe, unremitting pain, usually in the feet, worse at night, and relieved by hanging the feet over the edge of the bed. This is a sign that the circulation has reached a critical stage, and that the limb is threatened.
Ulceration due to poor wound healing and tissue loss such as gangrene are all features of very advanced PVD.
How is the diagnosis confirmed?
In addition to the symptoms, clinical examination may reveal a loss of pulses in the leg. A more accurate assessment of the state of leg circulation can be obtained by non-invasive Doppler studies in the vascular laboratory.
In advanced stages, changes may occur to the skin and nails, referred to as trophic changes. These include thin, shiny skin, brittle nails and loss of hair. Reddish discolouration of the feet (positive Buerger’s test) is a sign of severe impairment of the circulation.
Are any special tests required?
Angiography provides a roadmap of the circulation to the legs. It is performed in the Catheter laboratory (under operative conditions). It involves injecting contrast material directly into the artery (usually via the femoral artery in the groin), and X-rays of the arteries. In some cases, it is possible to treat the narrowing/blockage at the time of the Angiogram, using balloon angioplasty or stenting procedures.
Alternatively, an angiogram can be performed using the CT scan. This is performed using an injection of contrast into a vein providing excellent images. Treatment of the blockages is not possible with this technique.
What can be done to treat PVD?
For many patients with Peripheral Vascular Disease, intervention is not required. There can be a spontaneous improvement in walking as alternative or collateral blood vessels open out. Initial management involves risk factor management with advice to quit smoking, lose weight, regular exercise, blood pressure control and dietary advice. Those who stabilize or continue to improve, may not require intervention at all.
For patients whose symptoms do not improve or stabilize, or those with more severe symptoms of PVD such as rest pain, tissue loss or non-healing ulceration, then intervention is required.
This may be performed using endovascular techniques (with balloons, catheters and stents) or by open operation.
The choice of intervention depends on numerous factors, such as the location, extent and severity of the blockage.
Where the site of the lesion is a tight narrowing or short blockage, it may be possible to treat with a balloon or stent. If the lesion cannot be treated in this way, operative treatment such as a bypass, or re-bore (endarterectomy) may be considered.
What is the success rate?
The success of the procedure, whether endovascular or open, varies depending on numerous factors, and a successful outcome can never be guaranteed. The risks and possible adverse events can vary depending on the precise procedure.
If you are experiencing symptoms of Peripheral Vascular Disease, our experienced team at North Western Vascular can give you a tailored treatment plan. Call us now on (03) 9372 9999 or contact us to book a consultation.