Peripheral Vascular Disease

What is peripheral vascular disease?

Peripheral vascular disease is a term that is used to describe a build up of disease, or atherosclerosis, in the arteries outside the heart. The causes of this are the same as those that lead to coronary artery disease, andinclude age, smoking, high cholesterol, high blood pressure, diabetes, male gender and a family history of vascular disease. Narrowed vessels cause a reduction in blood-flow to organs and muscles depending on which arteries are affected. In clinical practice, narrowing of the blood vessels that supply the legs often cause problems. The worse the narrowing, the more severe the symptoms, and the speed of onset of symptoms depends on the underlying cause.

What are the symptoms of peripheral artery disease?

The function of blood vessels is to carry oxygenated blood to tissues, enabling them to function correctly. If the demand for oxygen in muscles is greater then the blood-flow available, toxic metabolites will build up which lead to reduced function and pain. In the legs this causes 'intermittent claudication', which is usually felt as a cramp-like aching in the lower legs when walking. Occasionally it is also felt in the thigh and buttocks. This pain usually comes consistently after walking a certain distance, and causes the sufferer to take a rest for 1-2 minutes before setting off again. If the disease progresses then pain can occur even at rest. This can even cause ulcers to form, or minor injuries not to heal. This is called 'critical limb ischaemia' and may require urgent treatment.

Acute limb ischaemia

On occasions the blood vessels may become suddenly blocked. This can even happen in those with no previous symptoms in an otherwise normal circulation. The limb will become suddenly cold, painful and pale with a bluish tinge. If left to progress reduced sensation and numbness will occur. Regardless of the cause, medical attention should be sought immediately by calling the emergency services, as urgent treatment will be required to salvage the limb.

Popliteal aneurysms

In the same way that aneurysms develop in the abdominal aorta, the artery behind the knee is susceptible to aneurysm formation. These aneurysms tend to clot rather than burst, and this causes the blood supply to the leg to become suddenly cut off. Sometimes this can happen before the aneurysm is known about. People who have abdominal aortic aneurysms diagnosed should have a scan to ensure there is no popliteal aneurysm, as 30% will. If prominent, they may be noticed as a pulsating swelling behind the knee. Depending on the size of the aneurysm, surgery may be advisable to prevent later complications.

Investigations

The most informative investigation is a duplex ultrasound scan of the arteries. This shows the blood-flow in the arteries, and can identify where any narrowing may be. This is done as an outpatient and involves placing a hand-held scanner onto your legs and scanning up and down. CT or MRI angiography can also be used to provide more complex, three-dimensional images of the arteries. This may require an injection but is also done as an outpatient. Occasionally patients may require an angiogram, which involves an injection directly into the affected blood vessels, to aid the diagnosis of the problem.



The medical information provided here is intended solely for patients of the London & Surrey Vascular Clinic, it is general information only and should not be used as a substitute for personal advice received when consulting your own surgeon face-to-face.

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