Lower Extremity Arterial Problems

What are Lower Extremity Arterial Problems?

Lower extremity arterial problems are also known as peripheral arterial disease (PAD), peripheral vascular disease, atherosclerosis, or hardening of the arteries.

When the peripheral arteries that bring blood to the lower body narrow and become blocked, blood flow is restricted. Over time, this restriction causes less oxygenated blood to flow to the body tissue in the lower extremities causing a condition called ischemia. Ischemia produces symptoms such as leg pain or cramps with activity, changes in skin color, sores or ulcers, and a feeling of fatigue in the legs. If left untreated, circulation to certain areas can be completely restricted, which can lead to gangrene and even the loss of a limb.


Causes of Lower Extremity Arterial Problems

When plaque (cholesterol, calcium, fibrous tissue, and other debris) builds on the artery walls, it causes them to harden and narrow. This process is called atherosclerosis. Healthy arteries are flexible and allow oxygen- and nutrient-rich blood to all areas of the body.

Similar to the blood vessels of the heart, peripheral arteries that carry blood to the legs also may develop atherosclerosis. Over time, the buildup narrows the artery and restricts blood flow.

Symptoms of Lower Extremity Arterial Problems

Lower extremity arterial problems can develop over a lifetime. Early in the disease process, there are little or no symptoms. As the disease progresses and oxygen is restricted to the lower body, symptoms may include: 
  • Pain while walking or exercising, especially in the calf, buttocks, or thighs
  • Weakness, heaviness, or fatigue in the legs when walking or exercising
  • A burning or aching in the feet and toes while resting, especially at night while lying flat 
  • Cool skin temperature in the feet 
  • Color changes in the skin 
  • Toe and foot sores that do not heal 
Having one of the above symptoms does not mean that you have lower extremity arterial problems. This list should be used as a guideline only. If you are experiencing one or more of the above symptoms, please call your doctor.

Risk Factors of Lower Extremity Arterial Problems

At Yale Vascular Surgery, we emphasize patient education, risk-factor reduction, and management. Knowing your risk factors for any disease can help to guide you to the appropriate actions, including changing certain behaviors and being clinically monitored for the disease.

Factors that increase the risk for developing lower extremity arterial problems include: 
  • Smoking 
  • Diabetes 
  • Older age 
  • Gender: Men are more likely to develop the disease 
  • High blood pressure 
  • High cholesterol 
It is important to understand that having one or more risk factors does not mean that you will develop the disease. This information should be used only as a guideline.

Diagnosing Lower Extremity Arterial Problems

If you think you have lower extremity arterial problems, it is important to get a diagnosis so that you can begin treatment and management of the disease to prevent further issues.

Yale Vascular Surgery uses the most innovative techniques to diagnose vascular conditions so that you can receive a timely and accurate diagnosis. In addition to using diagnostic procedures, our surgeons take the time to discuss your medical history and perform a physical examination.

Below describes the most common diagnostic procedures: 

Ankle/Brachial Index (ABI)
An ankle/brachial index compares blood pressure measurements taken in the lower leg with those taken in the arm. 

Pulse Volume Recording (PVR) 
A pulse volume recording measures the blood volume changes that occur in the legs. In order to get the measurement, blood pressure cuffs are placed on the arm and leg and inflated slightly while the patient is lying down. Then, the pressure in the cuffs is decreased and the patient walks on a treadmill until their leg pain develops. The blood pressure cuff measures the blood flow and a recording device displays the pulse volume differences as a waveform on a monitor. 

Ultrasound
An ultrasound uses high-frequency sound waves and a computer to create images of blood vessels and to assess the blood flow within the vessels. 

Arteriogram (Angiogram)
An arteriogram is an X-ray image of the blood vessels. A dye is injected into the artery through a thin, flexible tube. This dye makes the blood vessels visible on the X-ray.

Computed Tomography (CT) Scan
A CT scan is an imaging procedure combining X-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of the blood vessels.

Treatment of Lower Extremity Arterial Problems

Treatment of lower extremity arterial problems may include management of risk factors that may cause the disease to worsen and/or surgery. 

At Yale Vascular Surgery, our team includes nationally renowned surgeons who are dedicated to helping patients affected by vascular disease and who have continually excelled in caring for patients with lower extremity arterial. They will help determine the best-possible comprehensive treatment by using the latest technology and compassionate care.

Should you require surgery, our surgeons will review your surgical plan with you, in detail, so that you know what to expect before, during, and after the surgery.

Management of Lower Extremity Arterial Problems

The management of lower extremity arterial problems may include modifying outstanding risk factors, such as quitting smoking or changing your diet, and medications that can control possible risk factors, such as high blood pressure. 
Sometimes, clot-dissolving medications are administered through a small catheter placed inside the artery to remove the clot and restore normal blood flow. This treatment is called thrombolysis.

Surgery for Lower Extremity Arterial Problems

Angioplasty
An angioplasty is a minimally invasive procedure that helps improve the circulation in your legs. During an angioplasty, a long, thin, flexible tube, called a catheter, is inserted into a small incision. The catheter is guided through your arteries to the blocked area(s). Once there, a special balloon attached to the catheter is inflated and deflated several times in order to widen the artery walls. In some cases, a tiny stent (a mesh-metal tube) is placed into the narrowed area of the artery to keep it open. 

Atherectomy (laser or mechanical)
This procedure removes plaque from arteries using a catheter inserted inside of the artery with blockages. 

Bypass 
For more extensive blockages, bypass surgery may be required.

In bypass surgery, a Y-shaped tube made of synthetic fabric, called a graft, is attached to the aorta above the blockage to create a detour around the narrowed or blocked sections of the artery.