FAQs About Vascular Disease

Millions of people, especially the elderly, are affected by diseases of the arterial blood vessels (also known as hardening of the arteries, atherosclerosis, peripheral vascular disease and poor circulation). Diseases of the arterial blood vessels are caused when fatty substances build up inside the artery walls over time and create a blockage which limits proper blood flow, making it difficult to have oxygen reach the area supplied by that artery. This can lead to symptoms of pain in the legs or hips that occurs with exercise (claudication), or may lead to stroke, heart attacks and, in the worst of cases, limb amputations and earlier

What is peripheral vascular disease?
Poor circulation, often known as peripheral vascular disease, is often due to atherosclerosis, or "hardening of the arteries". Atherosclerosis is caused when fatty substances build up inside the artery walls over time and create a blockage which limits proper blood flow. This is most likely to occur in the lower abdomen leading to the legs (aorta, iliac, femoral and popliteal arteries) , in the kidneys (renal arteries), in the neck leading to the brain (carotid arteries) and in the arms (subclavian and brachial arteries).
 
Peripheral vascular disease is often a disabling disease and is thought to affect up to 20% of the elderly population. The disease is associated with increased mortality, decreased functional status and decreased quality of life.
 
How do I know if I have peripheral vascular disease?
When muscles in the body do not receive an adequate supply of blood due to a blockage, they do not get enough oxygen and this causes pain. If the blockage occurs in the arteries supplying the legs, there can be a cramping pain in the hips, thighs or calf muscles and this can limit your ability to walk. If the pain in these areas is relieved with rest, we call this condition "intermittent claudication". If blood circulation becomes so severely limited that the legs and feet are always starved for blood, gangrene or death of the tissue can occur. Without treatment, part of the leg or the foot may have to be amputated or ulcers that develop may not properly heal.
 
Other symptoms of peripheral vascular disease in the legs may include: coldness of the leg, foot, or toes; paleness of the leg or foot when elevated; blue discoloration of the foot or toes; dry, fragile or shiny-looking skin; numbness, tingling or pain in the leg, foot or toes; and sores or ulcers that may not heal. Symptoms of peripheral vascular disease in the kidney (renal arteries) include significantly high blood pressure and abnormal kidney function blood tests.
 
Symptoms of peripheral vascular disease in the neck (carotid arteries) may include sudden weakness or numbness of the face, arm or leg on one side of the body, sudden dimness or loss of vision, loss of speech, or trouble talking or understanding speech. These can be symptoms of a stroke or mini-stroke (TIA).
 
When any of these symptoms occur, a history and physical examination and usually a noninvasive ultrasound Doppler test are initially performed by a doctor. The ultrasound Doppler test performed in the noninvasive testing laboratory provides an image of the inside of the arteries using sound waves to determine if there is a blockage, and if so, to what extent. This test is quick, painless, and is often performed as an outpatient procedure. If the test shows significant narrowing of an artery, then a test called an arteriogram or aortogram may be performed which will give your doctor more complete information to properly diagnosis your condition. This test uses dye given through a catheter to further evaluate the extent of blockage in the artery.
 
It is possible that you have peripheral vascular disease but you do not have any symptoms because the blockage in the artery is not severe enough to cause a significant decrease in the blood supply to that area. Tests are available to estimate the level of peripheral vascular disease, if present. Even patients with evidence of peripheral vascular disease but with no symptoms should be routinely monitored to try to prevent the disease from becoming worse over time.
 
How do you get peripheral vascular disease?
A number of risk factors for peripheral vascular disease have been identified. These include:
cigarette smoking
diabetes mellitus
high blood pressure (hypertension)
high cholesterol levels
obesity
lack of physical exercise
family history of vascular disease
 
We will educate you on how to best control any of the above risk factors.
 
What can be done if I have peripheral vascular disease?
Many treatments, both surgical and non-surgical, can be used to improve blood flow through the coronary or peripheral arteries. The latest non-surgical interventions for treating peripheral vascular disease can bring relief of pain and may eliminate the need for surgery. Techniques now available include the use of balloon catheters and stents. These procedures treat the build-up of plaque by either removing it, or pressing it up against the blood vessel wall to let more blood flow through the artery. If the blockage is extremely long or has become very hard and calcified with time, it may be resistant to any of these interventions. In these cases, surgery may be required to bypass the problem area. It is very rare that amputation of the affected area is needed.
 
The care of each patient is individualized and therapy is best determined by a team of vascular specialists. Some patients may improve with medications or exercise programs and may not need more invasive procedures. Also, newer medical treatments are being developed and may someday include such things as growing new blood vessels (angiogenesis).
 
Why would exercising help if I get pain in my legs when I walk?
Exercise (walking ) programs as a treatment for lower extremity claudication have been recommended for over 40 years. All studies of exercise programs in patients with peripheral vascular disease have reported an increase in exercise performance and a lessening of claudication pain severity during exercise. Thus, exercise training improves the ability to walk for longer periods of time without claudication. Exercise training programs can have an important impact on a patient's quality of life.
 
Exercise rehabilitation is generally conducted in a supervised (usually hospital) setting, using a treadmill. Exercise is continued for short periods of time until the first signs of claudication. There are rest periods between the exercise times to allow the claudication pain to subside. These exercise and rest sessions are repeated for 30 to 60 minutes, 2 to 3 times a week for a total duration of 3 to 6 months. Over time, exercise tolerance is built up gradually.
 
Exercise rehabilitation is a highly effective type of treatment for patients with peripheral vascular disease. The great majority of patients who participate in such a program will improve their walking ability. The benefits of a supervised walking exercise program have been consistently demonstrated in persons with PAD and exercise training constitutes an important form of therapy for these persons.
 
Are there medications that can treat peripheral vascular disease?
There are numerous medications that can treat claudication and each patient's response to these medications can be different. Some of these have not proven to be of much use in some patients and often the medications need to be taken for several months before beneficial effects are seen. Our team of doctors can give you more information about these medications and their possible side effects and whether or not they are appropriate in your care.
 
What is an Aneurysm?
An aneurysm is n enlargement of the artery caused often by a weakness in the wall of the artery. They often occur in the aorta, either in the chest cavity (thoracic aorta) or in the abdomen (abdominal aorta). An abdominal aortic aneurysm can sometimes be detected by a physical exam. Other tests can also identify it, such as an ultrasound or CT scan. The size of the aneurysm is often used to determine when surgery or other therapy is needed to repair it. If there is a more severe complication of the aneurysm, sometimes referred to as a dissection, more immediate therapy may be needed.