Peripheral Vascular Disease

Peripheral artery disease (PAD) is a problem that occurs when blockages form in the circulation carrying blood from the heart to the body. The legs are most commonly affected.

The most common causes of a blockage are:

• a plaque in the wall of blood vessels carrying oxygen to the body tissues
• a blood clot that has travelled from the heart

Arteries are made up of a number of layers, all of which help move oxygen-rich blood to the major organs and tissues around the body. Damage can occur to these layers over time due to genetics and a number of lifestyle factors. This allows fatty deposits, cholesterol, and calcium to build up in the wall of the arteries, known as atherosclerosis.

Over time, plaque can grow and narrow the arteries to the legs. The more severe this gets, the less oxygen gets to the feet and toes below.

There are a number of factors that put people at risk:

• Increasing age
• High blood pressure
• High cholesterol
• Smoking
• Diabetes

There are many ways peripheral artery disease can present, the most common being:

• Cramping pain in the calf, especially walking uphill or over longer distances
• Pain in the feet or toes, even at rest
• Wounds that won't heal
• Black spots or gangrene

If you or your family member have any of the risk factors listed above, you may be recommended for an Arterial Duplex. This is a very specific non-invasive ultrasound scan of the arteries supplying the legs, starting from the abdomen to the feet. Ultrasound does not use radiation or contrast dye, so it is very safe. It looks at the blood flow and degree of plaque.

Patients who present to hospital with sudden onset of a cold, pale leg compared to the opposite side may undergo further imaging with a CT Scan and contrast dye.

Once diagnosed, a treatment plan will be discussed with Dr Bullen. The decision on what option is best for your condition is based on review of your history, physical examination and the results of your investigations.

All patients with a diagnosis of Peripheral Arterial Disease will be treated with medications to reduce their risk, some may also require surgery. There are two main types:

• Angiogram with ballooning or stenting is a minimally invasive (keyhole) treatment which uses specialised Xray and dye. It involves inflating a balloon within the plaque to open the channel and increase blood flow to the affected area. The newly opened channel may be supported by inserting a stent (metal scaffold).

• Endarterectomy or bypass surgery are open surgical procedures that either remove the plaque inside the blocked artery or divert the blood flow around it using a bypass.

The type of treatment offered will depend on your age, health issues and extent of disease. We aim to fix your problem safely and with the shortest possible recovery time.