Peripheral Vascular/Arterial Disease

(claudication, rest pain, limb salvage)

Peripheral vascular/arterial disease (PVD/PAD) refers to any disorder or disease of the network of blood vessels that carry blood throughout the body. As plaque builds up (atherosclerosis) in the lining of the blood vessel walls, a decreased amount of oxygen rich blood is carried to the legs or arms.

Signs and symptoms of peripheral arterial disease include: Pain/fatigue when walking, pain with the leg/foot at rest, coldness of extremity, or poor healing of distal wounds.

Risk factors of PVD/PAD include: Smoking/nicotine use, hypertension (high blood pressure), end stage renal disease (ESRD), diabetes, high cholesterol, being physically inactive, other diagnosis of coronary artery disease (heart vessel disease/CAD), past heart attack (MI) and increasing age.

Testing for PVD/PAD includes: Ultrasounds (ankle-brachial index) and CT angio scans.

When the arteries of the legs become narrowed or blocked due to atherosclerosis, the blood flow to the distal extremity becomes “ischemic” due to the lack of oxygen-rich blood flow. Upper extremity vascular disease is less common and often the result of atherosclerosis or a blood clot that has dislodged from a larger artery and blocked an artery in the arm.

If you suspect PVD/PAD or have been diagnosed, your vascular anatomy should be evaluated by a vascular specialist.

Treatment:

Many interventions are performed in a day-surgery setting at the hospital and are done with local anesthetic and light sedation in our catheterization lab. These are called endovascular/angiographic procedures and most patients can discharge the same day. Frequently, your surgeon can use balloons to stretch the vessels from the inside (angioplasty) or sometimes use stents to support the vessels open.

More extensive surgical procedures require general anesthesia, such as endarterectomies (focal plaque removal) and leg bypasses. A surgical bypass of an artery re-routes the blood flow around blockages. Surgeons may use a vein or prosthetic graft to ‘bypass’ the blocked artery to restore normal blood flow. These procedures tend to require a short stay in the hospital for recovery.

Vascular Surgeons are able to provide both approaches to our patients and are highly skilled at both. Depending on your vascular issue, your surgeon will discuss the option that works best for you.

In addition to the above treatment options, Washington Hospital has a Wound Healing Center to treat chronic, non-healing wounds. This center is staffed by specially trained nursing staff and physicians using state of the art techniques such as hyperbaric oxygen therapy.