Peripheral Vascular Disease

Often referred to as "poor circulation" Peripheral Vascular Disease (PVD) is a blood circulation disorder that includes narrowing, blockages of arteries.

Arteries are the blood vessels that carry blood away from the heart to supply your body with nutrients and oxygen, while veins carry blood back to the heart.

With PVD the arteries of the legs are most commonly affected, but any artery can be at risk including arteries of the arms, stomach and kidney. The most common symptom of PVD is intermittent claudication, which manifests as pain or cramping in the muscles of the legs especially with walking or other activities.

Most commonly, PVD is the result of structural changes. Inflammation, plaque buildup and tissue damage are among the top causes for PVD. These causes are often brought about by smoking, high blood pressure, diabetes, and high cholesterol. Extreme injuries to muscles or ligaments and infections can also cause this disease in some cases.

INDICATIONS:

Most patients present with subtle findings and can lack classic symptoms, which can make diagnosis difficult. Additionally, the symptoms associated with PVD in the legs can be similar to those more commonly associated with lower back issues.

SYMPTOMS OF PVD IN THE LEGS:

The most common early symptom is intermittent claudication, which is discomfort or pain in your legs that happens when you walk and goes away when you rest. You may not always feel pain; instead you may feel a tightness, heaviness, cramping, or weakness in your leg with activity.
IC often occurs more quickly if you walk uphill or up a flight of stairs. Over time, you may begin to feel IC at shorter walking distances. Only about 50 percent of the people with leg artery disease have blockages severe enough to experience IC.
Over time, you may awaken in the night with pain, tightness, heaviness or cramping in your legs. This is classified as rest pain may be relieved by dangling your leg over the side of the bed or moving to the upright position, such as a recliner.
Physical changes in the legs can include abnormal skin color, poor hair growth, cool skin, delayed healing of wounds, or color changes of your toes or feet.

**If you have any of these risk factors or symptoms and are concerned you may have PVD, you should be evaluated by one of our Board-Certified Vascular Surgeons.**

PRE-OP EVALUATION AND PREP:

As experts in the diagnosis and management of PVD, our Board Certified Vascular Surgeons and Registered Vascular Technologists use advanced screening to identify the condition at every stage. Physical examination findings in patients with PVD vary. They may include absent or diminished pulses, abnormal skin color, poor hair growth, and cool skin.
Once PVD is suspected, a variety of tests can be done including ankle-brachial index, ultrasound, CT angiography, and angiogram to determine the severity and location of the compromises vessels. For minor blockages, medication and/or a walking program may be prescribed. For major and persisting conditions an angioplasty or stenting procedure can be performed. For more advanced disease states, a combination of surgery and minimally invasive procedures are recommended.

Once PVD is suspected, a variety of tests can be done including ankle-brachial index, Doppler Ultrasound, CT Angiography, and Diagnostic Angiogram to determine the severity and location of the compromises vessels. For minor blockages, medication and/or a walking program may be prescribed but for major and persisting conditions an angioplasty or stenting procedure can be performed. For more advanced disease states, a combination of surgery and minimally invasive procedures are recommended.

PROCEDURE:

Diagnostic Angiogram
An angiogram is an imaging test that uses x-rays to view your body's blood vessels. Your surgeon will use this test to study narrow, blocked, enlarged, or malformed arteries of your body, including your brain, abdomen, arms, and legs. When arteries are studied, the test is also called an arteriogram.

To create the x-ray images, your surgeon will inject a liquid, sometimes called a 'dye', through a thin, flexible tube, called a catheter. The surgeon threads the catheter into the desired artery from an access point. The access point is usually in your groin but it can also be in your arm. This 'dye', properly called contrast, makes the blood flowing inside the blood vessels visible on an x-ray. The contrast is later eliminated from your body through your kidneys and your urine. Your surgeon may recommend an angiogram to diagnose a variety of vascular conditions.

An angiogram may be done to check:

Blockage of an artery
Enlargements of the arteries, called aneurysms
Kidney artery conditions
Malformed arteries

Sometimes your surgeon can also treat a problem during an angiogram. For instance, your surgeon may be able to perform an angioplasty (ballooning) and/or stenting procedure to clear blocked arteries during an angiogram, depending on the location and extent of the blockage. An angiogram can also help the surgeon plan operations to repair the arteries for more extensive problems.

Angiogram with Angioplasty and/or Stent Placement

An angioplasty, often referred to as a "balloon," is a procedure performed to widen the stenosis (or narrowed) artery with a small catheter attached to a balloon. The balloon is placed inside the artery over a series of small wires during the angiogram. The balloon is inflated and re-opens the blocked portion of the artery. Upon completion, the balloon is completely removed.
For more persistent blockages stenting is done at the same time as the angioplasty. Stenting results in permanently placing a small metal mesh tube in the narrowed area of the artery.

How are these procedures done?

You will lie on your back on a firm table. A small area of your upper leg or groin will be cleansed with an antiseptic prep solution. A sterile drape will be placed over the area to keep it clean. A numbing medicine will be placed under the skin in the area where the angiographic catheter will be placed. Most patients are made comfortable for this procedure with mild to moderate sedation.

Your surgeon will then insert a narrow tube called a catheter into the blood vessel. A special medicine called contrast, which allows blood vessels to be seen with x-rays, will be injected through the catheter.

A series of x-rays will be taken with a high speed x-ray camera. For a few seconds as the contrast material is being injected, you may:

Feel warm
Have a metallic taste in your mouth
Feel the need to go to the bathroom

The injection and filming may be repeated several times to show different blood vessels.

The catheter will be removed and the surgeon will either place a closure device into the puncture site or someone will hold pressure on the site for about 10 to 15 minutes to prevent bleeding. You will then be taken to the recovery area.

The length of this test will vary based on your test results. The staff will make every effort to keep you as comfortable as possible.

The surgeon will study your x-rays very carefully and discuss the findings of your studies with you before you are discharged.

How do I prepare for this procedure?

There are few things you need to do to prepare for an angiogram:

If you take medicine for diabetes, such as insulin or Glucophage (also called Metformin), be sure to notify your surgeon.
If you take Coumadin or other blood thinners, notify your surgeon.
Ask your doctor if you should adjust any of the other medicines you are taking before this test.
We will call you the day before your procedure to let you know when to stop eating and drinking in preparation for the procedure. If you have morning medicines to take, you may have a small sip of water to take your pills.
You will need to plan to be at the office for about 3 to 7 hours.
If you are allergic to contrast or iodine, let the staff know as soon as possible.
You will need to have an adult take you home and stay with you for the next 24 hours.
Click here for pre-surgery FAQ

What care is done after the procedure?

In the recovery area, you will be observed for 2 - 6 hours before you go home. Your blood pressure, heart rate, breathing and oxygen rate will be monitored, as well as your catheter site. You will need to lie quietly with your leg or arm straight. Click here for post-surgery FAQ

Home care after your procedure:

A friend or family member must drive you home without making stops along the way. Someone should also stay with you while you rest until the next morning.
Limit your activity after this test to help your recovery and prevent complications.
Get up only to use the bathroom and eat.
If the leg site was used, stairs should be climbed only one step at a time, favoring the affected leg.
Gradually increase your activities the next morning, but do not plan to work the day after your angiogram.
Do not drive for 24 hours.
Do not lift any objects weighing more than 8 to 10 pounds for 5 days from the time you leave the office. (A gallon of milk weighs just over 8 pounds.)
If the catheter was in your leg, limit bending at the waist for 48 hours.
If you want to clean up after the angiogram, take a sponge bath. Wait until the next morning to shower or take a tub bath.
Remove your band-aid the morning after the test. As you shower or bathe, wash the puncture site gently and pat it dry. Do not scrub the site.
If you feel that you are going to cough, sneeze, or if you need to bear down for a bowel movement, apply gentle pressure to the puncture site with your hand.

Long-Term Management of Peripheral Vascular Disease

PVD is a condition that requires life-long management, even after an endovascular or surgical procedure. Our team of Board Certified Vascular Surgeons will see you on an ongoing basis to perform routine testing and to discuss any new developments or changes that may occur over time with this condition. It is important that you pay attention to any changes you notice over time and promptly report these changes to your surgeon.

Management of PVD over time includes working to address the underlying issues that contribute to the condition including smoking cessation and following your primary care physician's plan for the management of high blood pressure, diabetes, and high cholesterol. You will also need to take steps to prevent the development of any sores or wounds on your toes, feet and ankles.

Please see the attached information about resources to help quit smoking as well as the tip below about maintaining good foot health!

Stop Smoking (PDF)
Benefits of Quitting Smoking (PDF)

Tips for maintaining foot health:

Inspect feet and nails regularly
Use mild soap to wash feet, and always dry thoroughly
Use lotion as needed to prevent dry, itchy or cracked skin
Wear properly fitting shoes and clean cotton socks (avoid shoes that consistently rub against your foot in the same spot)
Make sure insides of shoes are brushed out and free from any debris that could rub against your feet unknowingly
Trim toenails regularly. Seek the professional services of a podiatrist if needed.

For More Information

To listen to our board certified surgeons answer your most frequently asked questions, please visit our FAQ page.

To Make an Appointment

Your initial consultation gives you the opportunity to meet our team, learn more about our services and find out which treatment options will best meet your needs.

To schedule a prompt appointment with one of our board-certified vascular surgeons, Please call Columbia Surgical Associates at 573-443-8773.
Dr. Salinas
Dr. Adams
Dr. Sanford

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