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Early detection saves limb. Peripheral arterial disease, or PAD, refers to a reduction in blood-flow to the legs and feet. PAD is caused by hardening of the arteries or atherosclerosis, in which fatty deposits called plaques build up along the walls of the arteries. This buildup can reduce blood-flow, or block it completely. When blood-flow to the legs and feet is reduced, two conditions can result:
Claudication, the most common symptom of PAD, results in pain in the muscles of the buttocks, thighs and/or calves when walking.
People with critical limb ischemia, on the other hand, feel pain in their feet even when they are at rest, or develop non-healing sores on their feet. Those with critical limb ischemia are at risk for amputation.
See the above links for information on symptoms, risk factors, diagnosis and treatment for PAD specific to claudication or critical limb ischemia.
Description – Claudication refers to the pain, aching or fatigue of the muscles of the buttocks, thigh and/or calf that occurs with exertion. This pain or cramping is caused by poor circulation due to blockage of the arteries of the lower extremity.
Nearly nine million people, or 12 percent of the U.S. population, experience occasional claudication. This increases to 20 percent in people over the age of 70.
Claudication may occur in one or both legs, depending on where the blockage occurs. The pain is brought on by walking or exercise and disappears with rest. Claudication can range from being a mild nuisance to a disabling limitation.
Claudication is caused by atherosclerosis in the lower extremities is known as peripheral arterial disease (PAD). Atherosclerosis is the hardening and narrowing of the arteries over time through the buildup of fatty deposits, called plaque, along the artery walls. As plaques grow, they increasingly block the flow of blood through the arteries.
Artery blockages that cause claudication may be in the abdomen, pelvis, groin, thigh and/or the calf.
PAD is a risk factor for heart attack and stroke. A major treatment focus is to prevent these serious complications. Claudication can progress into the more severe critical limb ischemia. The aggressiveness with which it is treated will depend on the degree to which the claudication is interfering with the patient’s lifestyle.
PAD symptoms may include
Pain in the buttocks, thigh and/or calf, occurring with walking
Tired or burning sensation in the buttocks, thigh and/or calf with walking
Risk factors for claudication are the same as those for atherosclerosis, hardening and narrowing of the arteries due to the buildup of fatty deposits called plaque:
Diagnosis: Your doctor may identify and locate the cause of claudication using one or more of the following methods: Auscultation: The presence of a bruit, or “whooshing” sound, in the arteries of the legs is confirmed using a stethoscope.
Ankle-brachial index (ABI): The systolic blood pressure in the ankle is divided by the systolic pressure at the arm.
Doppler ultrasound: This form of ultrasound can measure the direction and velocity of blood flow through the vessels.
CT angiography: An advanced X-ray procedure that uses a computer to generate three-dimensional images of blood vessels.
Magnetic resonance angiography (MR angiography): The patient is exposed to radiofrequency waves in a strong magnetic field. The energy that is released is measured by a computer and used to construct two- and three-dimensional images of the blood vessels.
Angiogram: An X-ray study of the blood vessels using contrast dyes.
Reducing risk factors: Treatment for claudication usually focuses on the reduction of risk factors associated with atherosclerosis.
Smoking cessation
Walking, usually 30 minutes a day
Medication and lifestyle changes aimed at reducing cholesterol, blood pressure and blood-sugar levels
Medication, such as aspirin, to prevent heart attack and stroke
Medication to improve walking distance, such as cilostazol (Pletal)
Diet low in saturated fats
Endovascular treatments
Minimally invasive endovascular treatments may be recommended if claudication interferes with a patient's work or lifestyle, and if the diseased arteries are likely to improve with such treatment. The Vascular Center has the full complement of endovascular options available. The option recommended depends on the location and severity of the arterial blockages. In general, insertion of a catheter through a needle puncture, under local anesthesia, into the arteries of the groin will allow access to the diseased portion of the artery.
Some of the endovascular procedures used to treat claudication include:
Angioplasty: A tiny balloon is inserted through a puncture in the groin. The balloon is inflated using a saline solution one or more times to expand the narrowed or occluded artery.
Cutting balloon: A balloon imbedded with micro-blades is used to dilate the diseased area. The blades cut the surface of the plaque, reducing the force necessary to dilate the vessel.
Cold balloon (CryoPlasty): Instead of using saline, the balloon is inflated using nitrous oxide. The gas freezes the plaque during the dilatation. The procedure is easier on the artery; the growth of the plaque is halted; and little scar tissue is generated.
Stents: Metal mesh tubes are expanded and left in place to provide scaffolding for an artery that has been opened using a balloon angioplasty.
Balloon-expanded: A balloon is used to expand the stent. These stents are stronger, but less flexible.
Self-expanding: Compressed stents are delivered to the diseased site. They expand upon release and are left in place to hold open the artery. These stents are more flexible.
Laser atherectomy: Small bits of plaque are vaporized by the tip of a laser probe.
Directional atherectomy: A catheter with a rotating cutting blade is used to physically remove plaque from the artery, opening the flow channel.
Recovery from these procedures takes one or two days, and most of these procedures are done on an outpatient basis.
Surgical treatments : Patients who are severely limited by their claudication, but are not good candidates for minimally invasive endovascular procedures, may be given the option of surgical treatment. This treatment often involves bypass around the diseased segment with either a vein from the patient or a synthetic graft. Hospitalization after a bypass operation varies from a few days to more than a week. Recovery from surgery may take several weeks.
Description : Critical limb ischemia (CLI) is a severe blockage in the arteries of the lower extremities, which markedly reduces blood-flow. It is a serious form of peripheral arterial disease, or PAD, but less common than claudication. PAD is caused by atherosclerosis, the hardening and narrowing of the arteries over time due to the buildup of fatty deposits called plaque.
CLI is a chronic condition that results in severe pain in the feet or toes, even while resting. Complications of poor circulation can include sores and wounds that won't heal in the legs and feet. Left untreated, the complications of CLI will result in amputation of the affected limb.
The most prominent features of critical limb ischemia (CLI) are called ischemic rest pain — severe pain in the legs and feet while a person is not moving, or non-healing sores on the feet or legs.
Pain or numbness in the feet
Shiny, smooth, dry skin of the legs or feet
Thickening of the toenails
Absent or diminished pulse in the legs or feet Open sores, skin infections or ulcers that will not heal Dry gangrene (dry, black skin) of the legs or feet
Risk factors for chronic limb ischemia are the same as those for atherosclerosis, hardening and narrowing of the arteries due to the build up of fatty deposits, called plaque.
Diagnosis Your doctor may identify and locate the cause of blockages associated with critical limb ischemia (CLI) using one or more of the
Auscultation: The presence of a bruit, or "whooshing" sound, in the arteries of the legs is confirmed using a stethoscope.
Ankle-brachial index (ABI): The systolic blood pressure in the arm is divided by the systolic pressure at the ankle.
Doppler Ultrasound: This form of ultrasound can measure the direction and velocity of blood-flow through the vessels.
CT angiography: An advanced X-ray procedure that uses a computer to generate three-dimensional images.
Magnetic resonance angiography (MR angiography): The patient is exposed to radiofrequency waves in a strong magnetic field. The energy that is released is measured by a computer and used to construct two- and three-dimensional images of the blood vessels.
Angiogram: An X-ray study of the blood vessels is taken using contrast dyes.
Treatment : Critical limb ischemia is a serious condition that requires immediate treatment to re-establish blood-flow to the affected area. The number one priority is to preserve the limb.
Minimally invasive endovascular therapy is often an option in the care of CLI. The Vascular Center has the full complement of endovascular treatments available. The treatment recommended depends on the location and severity of the blockages. Most patients with CLI have multiple arterial blockages, including blockages of the arteries below the knee. In general, puncture of the groin, under local anesthesia, with insertion of a catheter into the artery in the groin will allow access to the diseased portion of the artery. Some of the endovascular procedures used to treat CLI include:
Angioplasty: A tiny balloon is inserted through a puncture in the groin. The balloon is inflated one or more times, using a saline solution, to open the artery.
Cutting balloon: A balloon imbedded with micro-blades is used to dilate the diseased area. The blades cut the surface of the plaque, reducing the force necessary to dilate the vessel.
Cold balloon (CryoPlasty): Instead of using saline, the balloon is inflated using nitrous oxide. The gas freezes the plaque. The procedure is easier on the artery; the growth of the plaque is halted; and little scar tissue is generated.
Stents: Metal mesh tubes that provide scaffolding are left in place after an artery has been opened using a balloon angioplasty.
Balloon-expanded: A balloon is use to expand the stent. These stents are stronger but less flexible.
Self-expanding: Compressed stents are delivered to the diseased site. They expand upon release. These stents are more flexible.
Laser atherectomy: Small bits of plaque are vaporized by the tip of a laser probe.
Directional atherectomy: A catheter with a rotating cutting blade is use to physically remove plaque from the artery, opening the flow channel.
Recovery from these procedures usually takes one or two days, and most of these procedures are done on an outpatient basis. Treatment includes management of the risk factors of atherosclerosis (see reducing risk factors).
Treatment of wounds or ulcers may require additional surgical procedures or other follow-up care. If the arterial blockages are not favorable for endovascular therapy, surgical treatment is often recommended. This typically involves bypass around the diseased segment with either a vein from the patient or a synthetic graft. Hospitalization after a bypass operation varies from a few days to more than a week. Recovery from surgery may take several weeks.