Peripheral vascular disease (PVD) refers to diseases of blood vessels outside the heart and brain. It’s often a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys. There are two types of these circulation disorders: Functional PVD doesn’t have an organic cause. It doesn’t involve defects in blood vessels’ structure. It’s usually short term and related to spasms that may come and go. Raynaud’s disease is an example. It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.
Organic PVD is caused by structural changes in the blood vessels, such as inflammation and tissue damage. Peripheral artery disease is an example. It’s caused by fatty buildups in arteries that block normal blood flow.
Symptoms of PVD depend on what artery is affected and how severely the blood flow is reduced. For example, you may experience a dull, cramping pain, numbness or tingling, or a change in skin color.
If your doctor suspects you may have PVD, he or she may order an ultrasound Doppler (a test that looks at blood circulation in the arteries of the legs to see if there is any blockage) or an ankle brachial test (measuring blood pressure at the ankle and in the arm while a person is at rest).
Treatments typically are medication, surgery, minimally invasive interventional procedures or a combination of these therapies.
Medications can be used alone or in combination with other treatments. Although the medicine doesn’t eliminate the narrowing of the arteries, it can help improve the efficiency of the heart and reduce symptoms such as leg pain, claudication (cramping pain and weakness in the legs) and hypertension (high blood pressure).
Sometimes bypass surgery may be required in the peripheral arteries if the atherosclerosis (hardening of the arteries) is severe enough. Bypass surgery is a way of creating new channels to carry blood around the blocked areas in your peripheral arteries. With the patient under general anesthesia, surgeons take a portion of a small blood vessel from the leg or chest to use as the new bypass artery. The surgeon sews one end of the bypass to the affected artery and the other end to the artery beyond the narrowed area. Blood then flows through the new vessel, bypassing or avoiding the blockage in the peripheral artery. Some of the common surgeries in the peripheral anatomy are femoral-popliteal bypass (for the legs) and renal artery bypass (for the kidneys).
Man-made grafts can be used, too. They are made out of synthetic tissues that are easily accepted by your body and work best on arteries at or above the knees.
The incision depends on where the blockage is, what type of graft is used and what’s best for the patient’s medical condition. The incisions are made on the inside of the leg. One long incision may be made to remove and prepare a leg vein; this incision goes from the groin to the top of the ankle. Some surgeons use several short incisions – about four that are three to four inches long each. In manmade grafts, two incisions are sometimes made: one at the groin and one where the blockage is.
Femoral popliteal bypass surgery is used for the upper part of the leg. Distal bypass is for the lower leg.
Percutaneous transluminal angioplasty (PTA) of the femoral arteries is a minimally invasive (without a large incision) procedure used to open the blocked or narrowed femoral artery and to restore arterial blood flow to the lower leg without open vascular surgery. A special catheter is inserted into the femoral artery. The catheter has a tiny balloon at its tip. The balloon is inflated once the catheter has been placed into the narrowed area of the artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening for the blood to flow through. A stent (a tiny, expandable metal coil) may be inserted into the newly opened area of the artery to help keep the artery from narrowing or closing again.
Not all PVD can be treated with PTA; the physician will determine the best treatment after considering many factors.
Santokba Durlabhji Memorial Hospital Cum Medical Research Institute
Bhawani Singh Marg, Jaipur