People who have peripheral arterial disease (PAD) or poor circulation commonly suffer from atherosclerosis. When atherosclerosis, also known as "hardening of the arteries" develops, it is due to the lining of the artery becoming rough and thickened. The thickening of the arterial walls is caused by a build up of fatty material or plaque, such as cholesterol. Clogging the arteries and decreasing blood flow. Plaque build up does not occur overnight but develope over many years. Ulcers may also form inside an artery. These ulcers have a rough surface which may cause particles of plaque or blood clots to dislodge into the circulation causing blockage of blood flow.
Atherosclerosis can cause the arteries to the legs to become narrowed or blocked; this is what is meant by lower extremity arterial disease. Signs and symptoms of decreased blood flow to the legs depend on the location of the arteries involved and the amount of narrowing. You may notice pain and/or cramps in the hips, thighs, or calves when walking specific distances, which is relieved by rest. This is called claudication. This symptom occurs when you walk because the leg muscles need more oxygen-rich blood during exercise, but are unable to get it due to poor circulation.
As atherosclerosis progresses, pain in the toes or feet may occur at rest. This is called rest pain, and occurs because the arteries are unable to deliver enough blood to the feet at rest. Rest pain is aggravated by elevation and improved by hanging the foot down in a dependent position. It usually occurs at night while your feet are up on the mattress and awakens you from sleep.
The most advanced stage of arterial disease is tissue necrosis, also known as gangrene. As the disease progresses, areas of injury may not heal and skin breakdown occurs, leading to gangrene (dead, black tissue).
Other Signs and Symptoms of Peripheral Arterial Disease (PAD)
Risk Factors for Arterial Disease
It is important to try and eliminate or minimize the risk factors that you can control, such as smoking, obesity, diabetes, and your activity level.
Non-invasive Venous Testing
Non-invasive Arterial Testing
Magnetic Resonance Angiography (MRA)
Pulse Volume Recording (PVR)
Invasive Arterial Testing
You will be required not to eat solid food eight hours before, and will need to stop liquids three hours before the angiogram. You will receive specific instructions regarding your medications, insulin, and blood thinners from your doctor or nurse before the test.
You will not be able to drive for one day following the procedure. Therefore you will need to make arrangements for someone to drive you home.
If you are diabetic please check your fingerstick the morning of your procedure.
For the test, an intravenous catheter is inserted into a vein in your arm and you may be given intravenous fluids and/or medications to help you relax. The femoral artery in your groin is most often used to insert a catheter in which to inject dye; however the artery in your inner elbow or armpit may also be used. The area is first shaven and then numbed with a local anesthetic.
A catheter is inserted into the artery and dye is injected and then x-rays are taken. You will feel a warm sensation in your body as the dye is injected. When the catheter is removed, the physician will apply pressure to the insertion site for approximately fifteen minutes. The procedure takes one to one and a half hours to complete. After the procedure you will need to be on bed rest with the affected leg or arm straight for four to six hours. This is to prevent any bleeding at the puncture site.
The dye acts like a diuretic, or water pill, so you may need to urinate frequently. You should drink a lot of fluids to help flush dye from your kidneys. Notify the nurse or doctor if you have any pain, numbness or tingling during or after the procedure.
Some of our patients will need to take a medication called Mucomyst the day before the procedure. Is is a small amount of a clear liquid with a bitter taste that can be taken in a small amount of fruit juice.
ONLY if we have indicated that you will need it, it will be taken as follows:
Please let your doctor or nurse know prior to the test if you are allergic to contrast dye or shell fish. Then we will take appropriate precautions.
If an angiogram is ordered on the day of admission, you should report to the specified area at the instructed time. Otherwise, you will receive a phone call from the Admitting Office with instructions for your arrival. If you do not receive a phone call by noon, please contact our office.
If you are to be admitted the day of surgery you will need to have pre-admission testing prior to your scheduled surgery. At pre-admission testing you will meet with an anesthesiologist, and nurse. You may have blood work, a urine test, EKG, and a chest x-ray. They will review pre-operative instructions including fasting and medications to take the morning of surgery.
The whole procedure takes approximately two to three hours. If you need to have any other testing we will try to schedule it the same day. If you are to be admitted the day before your surgery the above tests will be performed when you are admitted.
For same day surgery the hospital will notify you the day before your surgery after 2:00pm to tell you what time to report to the hospital. If your surgery is on a Monday you will be notified the Friday before your surgery.
TREATMENT FOR LOWER EXTREMITY ARTERIAL DISEASE
Angioplasty and Stenting
An antiplatelet agent is usually given prior to the procedure and for some time after 1-3 months or longer. These are used to reduce the risk of platelet aggregation (clumping) and thrombus (clot) formation. Plavix and aspirin are common antiplatelet agents that are generally prescribed before and/or after your stenting.
What can I expect after surgery?
Days 1 and 2 - Immediately after surgery you will be on bed rest and will not be allowed to eat or drink. Usually the following morning after being seen by the doctor you will be allowed out of bed to walk, and can resume eating. When you are out of bed, it is important to keep your legs elevated to minimize swelling. It is normal to have some swelling in the operative leg. If you have an urinary catheter, it will be removed the day after surgery. The nursing staff will keep a pillow under your legs to prevent pressure on your heels. It is important to keep pressure off of your heels at all times while you're in bed or in a chair. Physical therapy will be ordered if the nursing staff and/or physicians feel it is necessary for your recovery.
Days 3 to 7 - You will be encouraged to walk. The nurses will assist you until you are walking steadily. You may need a walker for safety initially. Once you are walking and moving around, and your doctor feels you are ready, you will be discharged from the hospital. The time of discharge is 10:00am
What can I expect when I go home?
What to Report
It is important to keep your follow up appointments. If any problems occur, do not hesitate to call the Vascular Group. There is always someone there to answer your questions.