Arterial Disease of the Legs

What?

 

Arteries supply blood to all parts of the body. Arterial disease causes the arteries to narrow and allow less blood through. Arterial disease commonly occurs in the arteries of the legs and this can cause issues.

Claudication is painful cramping in the legs that occurs with walking - mainly in the calves - due to not enough blood getting to the leg muscles.

Rest pain occurs when the arteries are very diseased. This makes the blood flow so poor that there is not enough oxygen to supply the tissue, even at rest. This pain usually occurs at night or when the leg is elevated.

Tissue loss is when ulcers or wounds occur and do not improve as not enough blood is getting to the area to allow healing.

Claudication is not usually dangerous and is self limiting. Rest pain and tissue loss are far more serious indicators that the blood flow is very poor and intervention is required.

Why?

 

Arterial disease is caused by a process called atherosclerosis, essentially inflammation and hardening of the arteries. This process causes the formation of plaques, which grow into the vessel lumen and slowly block the flow of blood.

Atherosclerosis is caused by a complex interplay of factors but certain risk factors make it more likely.

These include:

  • Smoking

  • Diabetes

  • Obesity

  • High blood pressure

  • High cholesterol

What can be done?

 

Treatment for arterial disease depends on how bad the disease is and where it is located. An ultrasound or CT scan will be required to locate exactly where the disease is and help plan any intervention.

All patients will benefit from lifestyle modification and medication optimisation. Exercising 30 minutes three times a week, improving diet, ensuring adequate blood sugar levels and ceasing smoking are important lifestyle modifications that will improve your arterial health. Medications that lower your cholesterol called statins will most likely be prescribed, as will a blood thinner such as aspirin. If your blood pressure is high suggestions will be made to improve this as well. Any diabetic medication will need to be adjusted to ensure your blood sugar levels are optimised.

Patients with claudication - cramping in the legs when walking - rarely progress or decline if they follow the above suggested lifestyle and medication adjustments. In fact, increased walking is the first line of treatment as it increases the body’s ability to make new blood vessels. Patients may find their pain improves as they walk further and more often. However, occasionally the pain is so lifestyle limiting that an operation needs to be performed. This either takes the form of keyhole stenting or bypass surgery, depending on the nature of the disease.

Surgery will only be considered after a trial of conservative management with the above listed lifestyle modifications and a walking regime. You will need to cease smoking for at least 3 months before surgery will be considered - this is because the risks of blocking your graft or stent are too high if you remain smoking.

Those patients with rest pain or tissue loss are at greater risk of poorer outcomes and will most likely need an operation to improve their blood flow. This will be discussed at your appointment. If your disease is particularly advanced, you may need to be admitted to hospital at the time of consultation.

A detailed description of arterial disease and treatment is available from the ANZ Society of Vascular Surgery via the link below