Lower Limb Arterial Insufficiency

Peripheral Arterial Disease

Patients who have difficulty walking, often have poor circulation. Poor circulation to the legs is caused by blockages in the arteries leading to them. Symptoms of poor circulation are muscle cramps in the calves or buttocks with walking. In addition, claudication may cause men to have erectile dysfunction. Typically, patients can walk several blocks before the onset of muscle cramps. With ten minutes of rest, the leg cramps subside enough for patients to walk again. This is repeated each time they walk. Patients with these symptoms have claudication.

Critical ischemia
Patients with severe blockages in their circulation develop (gangrene) blackening of their toes or feet or they have constant pain in the toes with or without exertion (rest pain). Patients often cannot sleep at night and have to dangle their legs over the side of the bed for relief. This is called rest pain. At its worst, rest pain can progress to tissue loss with either ulcer formation or gangrene. Patients with gangrene or rest pain are at risk of losing their legs. These patients need urgent evaluation and always need a procedure to increase blood flow to their legs.

Treatment options

Patients with claudication can be treated in one of five ways. The 1st treatment is risk-factor modification. This includes smoking cessation, diabetes control, cholesterol control, and blood pressure management. The 2nd treatment is walking exercise. By walking every day, claudication patients train their muscles to work more efficiently with less blood flow. This is what runners do when they train. The 3rd treatment option is medication. Currently, there are two medications approved for claudication and each one has advantages and disadvantages. Your vascular doctor can explain each medication and whether it is an option for you. The 4th treatment is angioplasty and stenting. Some patients have blockages that can be dilated with a balloon and sometimes a stent or tube-like scaffold is placed to keep it open. The 5th option is open surgery. This option is usually reserved for patients who have disabling claudication. Disabling claudication is life style altering and adversely affects a person’s quality of life or ability to work. An example of disabling claudication is the mail carrier who cannot walk because of severe claudication. Therefore if something isn’t done, he cannot work and earn a living.

Critical Ischemia
Patients with critical limb ischemia usually need a procedure. Usually this is a bypass from one artery to another artery using your own vein or a piece of plastic tubing. This increases blood flow to the legs and feet and allows wounds to heal. Endovascular techniques are also available for patients with critical limb ischemia. These newer techniques involve opening blockages from inside the artery with balloons and/or metal stents within an artery. In the worst case scenario, the amount of gangrene is too extensive or no arteries are available to bypass to. In this circumstance, a patient may need an amputation to relieve their pain or prevent the gangrene from becoming infected. Contact our Center for more information on what would be the best treatment option for you.

The doctors at our center are experts at treating claudication, rest pain and gangrene. Since the doctors are experienced in medical, non-invasive and surgical techniques– they can provide the best possible advice and all possible options for you. To contact us, call (973)972-9371.