Peripheral Vascular Disease
Patients who develop peripheral vascular disease often have a history of high cholesterol, smoking, hypertension and diabetes and a strong family history of arterial problems whether that is coronary artery disease or peripheral vascular disease. Patients will present with claudication which has the features of pain in the muscles, often in the legs which occur with exercise and is not present at rest. When the patient walks then the degree of blood getting to the muscles is reduced and so the oxygen levels fall and the patient starts to use anaerobic metabolism with the end product being lactic acid, which causes pain and cramping. The patient usually needs to stop to allow the oxygen to catch up again and then they can move off again. The distance is usually fairly regular.
The symptoms can become worse over time so that the patient initially is able to walk a good distance and then this distance reduces more and more as the narrowings or blockages of the arteries get worse. The patient can get to the stage where they can walk for only 20 or 30 meters before needing to stop. This can then deteriorate further to the point of pain at rest. This usually means that the percentage of circulation to the foot has usually dropped to 30% or less. The patient will find that they are able to tolerate any discomfort when sitting up but if they lie down in bed at night their foot starts to ache and wakes them up and they need to get out of bed and hang their legs down or walk around or sit out.
The blockages can get so severe that the next stage of deterioration is one of tissue loss with ulcers on the tips of the toes or ankles or heels and even gangrene starting to develop in the toes.
Patients who present with claudication or rest pain, ulceration and tissue loss with gangrene can be investigated using duplex ultrasound scanning. The pathology identified and the options of conservative management with a walking program versus intervention can be discussed. The interventions are either by open operation of by endovascular techniques. There are many therapeutic tools that are used including balloon angioplasty, drug coated balloon angioplasty, stenting and drug coated stenting with the use of covered stents being an option as well.
The approach to management will be discussed with you by Mr. Campbell once all of the diagnostic information is collated.
Permission for use granted by Cook Medical, Bloomington, Indiana.