What is it about ?
Peripheral artery disease is called peripheral artery disease when there is a narrowing or blockage in one or more arteries in the legs. The narrowing prevents sufficient blood from flowing to parts of the leg, potentially leading to severe symptoms and even necrosis of the leg (or part). Most people experience pain in their legs when they walk (limp), which goes away again with rest. This pain is explained by the fact that the body needs more blood during exertion, which is not possible because of the narrowing.
In 80% of cases, the symptoms remain relatively stable and no drastic measures are necessary. For the remaining 20%, however, the condition progresses gradually, and the artery will become completely blocked sooner or later. Critical oxygen deficiency in tissues, especially the muscles of the leg, is actually an advanced form of arterial disease. The circulation is so bad that you even feel pain in your feet or leg when at rest. Letting the affected leg hang out of bed helps relieve pain. Circulation problems also occur in the skin of the leg: cold feet with less sensitive skin, deformed nails, less hair on the lower legs and on the toes and wounds that heal poorly. In the terminal stage, the tissue may necrode, and the toe or skin turns black (gangrene).
If this is the case, you are eligible for surgery to unclog the blocked artery (s). This procedure is called revascularization, in other words the restoration of good circulation in the legs.
How does the doctor determine the need for surgery?
It is important for the doctor to assess who needs an operation and who does not. To do this, he has a whole series of examinations.
- THE’Duplex ultrasound : it is the combination of a ultrasound and a Doppler examination. During an ultrasound, the doctor uses sound waves to search for the artery in the leg. The Doppler technique makes it possible to measure the circulation. The computer converts the result into an image. This gives an image of the blood vessel and its diameter, as well as the speed of flow and direction of the flow of blood, which makes it possible to determine the precise location, the degree of narrowing and the possible presence of blood clots.
- MRI angiography with contrast : for this examination, a contrast product is first injected, then an MRI of the blood vessels is carried out. This gives the doctor detailed three-dimensional images of the blood vessels and lesions. It is on this basis that he can judge the need for surgery.
- Computed tomography angiography : this is a CT scan of the blood vessels. This exam is less precise than an MRI and is done in people who cannot have an MRI for one reason or another.
The treatment
Apart from emergency cases, the doctor will always recommend first Conservatory measures During three months :
- completely stop to smoke ;
- lose weight if necessary;
- lower cholesterol;
- treat diabetes and thehypertension ;
- move more, under control.
Often the doctor will also prescribe a anticoagulant. If these measures do not bring results and the symptoms are debilitating, he will consider an operation. Two possible surgical techniques are possible:angioplasty and the bypass. The choice depends on:
- the characteristics of the obstruction (short, long, with calcification, etc.);
- the availability of veins;
- patient preference;
- Cost ;
- etc.
A multidisciplinary team (cardiologist, internist, vascular surgeon, etc.) will make the decision in consultation with the patient.
- In case of’angioplasty, a small prosthesis (stent) is placed in a narrowed artery, so that the blood can circulate normally again.
- With the bypass, we use a “bridge” to bypass the blocked part. This “bridge” is made of synthetic material or a piece of vein taken from another part of the body.
- In the case of very poor circulation, urgent intervention is usually necessary. The choice of technique depends on the characteristics of the arteries (location of the narrowing, presence of calcifications, short or long obstruction, availability of good veins for possible bypass surgery, etc.) and depending on the general state of health of the patient (age, other diseases such as diabetes or heart disease, etc.).
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