Lower Limb Arterial Disease
Arterial disease in the legs
Peripheral Arterial Disease (PAD) starts when your arteries begin to narrow, which then reduces blood flow to your legs and body. PAD affects 9% of the population, but will become symptomatic in only about a quarter of those people.
An artery is a hollow tube, which takes oxygenated blood away from the heart to the organs and limbs. Inside the artery, it has a smooth surface for the blood to travel over. Sometimes, blood can leave behind fatty deposits, known as plaque, in your arteries (atherosclerosis) which then sticks to the inside of the artery. These fatty deposits can then build up and start to narrow the artery. This is commonly known as occlusive disease.
When PAD starts to get worse and develop symptoms, people may develop leg pain when they walk. Leg pain can include muscle pain or cramping but can then disappear after rest (intermittent claudication). The pain can vary depending on the severity of the disease. Other symptoms can also include leg numbness, skin colour changes, a weakness of pulse in your legs or sores to your feet and toes that will not heal.
Duplex ultrasonography of the legs involves looking at the arteries along the length of the leg, usually from abdominal aorta to the ankles and assessing the blood flow within them. This will identify narrowing or blockages within the arteries caused by atherosclerotic disease or blood clots, or other abnormalities of the arteries that may affect blood flow through the leg.
The scan will usually start at the abdomen or groin, and follow the arteries throughout their course in your legs down to the ankle – the blood flow is evaluated by imaging the vessels throughout the limb, and measuring the speed of flow through the legs. This assessment can therefore be quite noisy, but this is quite normal.
After the scan is complete, you will have your blood pressure taken in one or both arms and at both ankles. Dependent on the findings you may also be asked to perform a short exercise test (2 minutes) and have the blood pressure re-taken at the ankles afterwards to look for any changes.
What happens next?
Generally, you are able to treat PAD by stopping smoking, doing exercise and adopting a healthy and balanced diet. However, if symptoms do persist, we are able to offer a range of treatments, both with medication and surgery:
Most people with PAD are treated using medication. This can involve taking:
- Anti-platelet medication - Thins your blood and can help to prevent blood clots from forming on the plaque inside your arteries
- Statins - Helps to reduce your cholesterol levels
- Vasodilators - Allows the blood to flow better through your arteries by relaxing your blood vessels
For patients where medication has not been effective, surgery may be required to treat your symptoms. This can either be:
- Angioplasty or stent insertion – A tiny incision is made and a small hollow tube is placed into your artery. A balloon, which is attached to a catheter is then
- Bypass graft – This is a surgical procedure where a graft (hollow tube that is able to carry blood) is attached above the area of artery of occluded vessel and is reattached below the occlusion back to where there is a healthy vessel. This will help to provide better flow through the vessel and improve the blood supply. This is generally only performed for more advanced diseases.
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