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Peripheral vascular disease

What is Peripheral Vascular Disease?

Peripheral vascular disease results from a blockage or narrowing of the arteries which supply blood to the legs.  This is caused by disease in the wall of arteries known as atheroma, which develops gradually over many years.  It begins with fats (cholesterol) from the blood stream being deposited within the wall of arteries, leading to a chain of events which results in the thickening of the artery wall.  This results in a narrowing or blockage of the artery and a reduction of the blood flow to the leg.

What causes atheroma?

High blood pressure, raised cholesterol, diabetes, obesity and lack of exercise, may all lead to atheroma, but cigarette smoking is the most important cause. Atheroma occurs throughout the body and its consequences depend on which part of the body is affected.  In the legs, the arteries become narrowed so that there is insufficient blood to supply the exercising muscle.  Therefore, you get a pain or cramp in the leg whilst walking, which disappears after a couple of minutes rest.  If the arteries to the heart are affected then this may result in breathlessness, angina (chest pains) or a heart attack.  Similarly, a blockage of the blood vessels to the brain may result in a stroke.  Anyone who suffers with peripheral vascular disease (pain in the legs on walking) is likely to have some disease of the arteries that supply the heart and the brain.  Therefore, such patients are at increased risk of heart attack and stroke.

Treatment options

The majority of people with peripheral vascular disease have symptoms of pain in their calf when walking (this is called intermittent claudication).  This is caused by a lack of oxygen being delivered to the muscles of the legs when they are active.  As a result, the symptoms are relieved by stopping walking for a few minutes.  Only a minority of patients with intermittent claudication need treatment because the symptoms can be improved by lifestyle changes as listed below.

In the first instance, after a full medical history and examination, you will be offered a duplex scan of the blood vessels of your lower leg (this is a scan using a specialised ultrasound machine that is placed on the leg).  This scan will provide information on the extent of disease of the arteries supplying the muscle in the lower legs and whether any further treatment is required.

If the extent of disease of the lower leg arteries is severe you may have symptoms of continuous pain in your feet at rest (with or without ulceration).  This is a more serious symptom as it indicates that the blood supply to the leg is more severely compromised.  If you have these symptoms, after your initial appointment you may need an angiogram, an investigation which uses x-rays and dye which is injected into the artery in the groin under local anaesthetic.  An angiogram provides more detailed assessment of the lower limb arteries and also allows access to any disease arteries which can be balloon angioplastied or stented at the same time (in a similar fashion to the stenting of coronary arteries in patients with angina).

Occasionally, angioplasty of the disease arteries and stenting is not technically possible and patients with severe lower limb ischaemia may require lower limb bypass surgery.

The outlook

If you are suffering with peripheral vascular disease your outlook for the future is good, providing you follow the advice listed below.  There is very little risk of developing gangrene or needing an amputation. However, if you continue with your present lifestyle your legs will deteriorate and there will be a high risk of suffering a heart attack or stroke.

What can you do?

1. STOP SMOKING - this is the most difficult but most important lifestyle change you must make.  Stopping smoking will greatly reduce your future risk of stroke, heart attack and amputation.

2. TAKE REGULAR EXERCISE - research has shown that 30 minutes walking three times a week will double the distance you can walk without stopping, providing you persist with this regime.  It will also be beneficial in preventing heart disease

3. MEDICATIONS - you can greatly reduce your risk of a heart attack or stroke by taking one tablet of aspirin each day (75mg).  A prescription will be given to you so you can start this immediately.  If you are unable to take aspirin then an alternative tablet can be prescribed.

4. DIABETES AND HIGH CHOLESTEROL - there is now clear evidence that diabetes and high cholesterol are major factors causing heart attack and stroke.  These conditions will be screened in the vascular clinic and abnormal levels will be treated.

5. HIGH BLOOD PRESSURE - it is very important that high blood pressure is corrected to prevent a stroke or heart attack.

6. OBESITY - if you are overweight then weight reduction will reduce the risk of heart attack or stroke and will improve your exercise tolerance.  Dietary advice may be obtained from your GP or from dieticians based at the hospital.

7. FOOT CARE - it is important to wash your feet daily and cut your toenails carefully.  You must ensure that your shoes fit properly and do not cause blisters.  People who suffer with diabetes are at a particularly high risk of developing ulceration of the feet and should be referred to a chiropodist.

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