Much like the Coronary arteries, the Peripheral arteries can be blocked by Atherosclerotic plaque.
Causes of Arterial Blockage
Peripheral Vascular Disease can result from a condition known as Arteriosclerosis, which occurs when a waxy substance forms inside of arteries. This substance, called Plaque, primarily consists of cholesterol, fatty compounds, calcium, and fibrin (a blood–clotting material).
When enough Plaque accumulates in an artery, the blood flow through the area is slowed or stopped. This slowed blood flow may cause Ischemia, which occurs when the body’s cells do not receive enough oxygen. While a blockage of the Coronary arteries (the arteries that supply the heart) may lead to a heart attack, and a blockage of the Carotid arteries (the arteries that supply the head) may lead to a stroke, a blockage of the Peripheral arteries in the lower extremities most often produce pain and cramping in the legs. The risk factors for Atherosclerosis in the peripheral arteries are the same as for Atherosclerosis in coronary arteries. Smoking, diabetes, hypertension, and high blood cholesterol are believed to promote the development of plaque.
Symptoms of Arterial Blockage
Pain may occur in the calves, thighs, or buttocks, depending on where the blockage occurs. Frequently, the severity of the pain is an indicator of how severe the blockage is. In serious cases, the toes may turn a bluish color, the feet may be cold, and the pulse in the legs may be weak. Rarely, Gangrene may set in and Amputation may become necessary.
Sometimes, leg cramps develop when a person walks, usually worsening with more strenuous exertion. This is called Intermittent Claudication. Like the chest pain (Angina), leg pain associated with Intermittent Claudication usually fades with rest. Exposure to cold temperatures and some medications may also bring on leg pain.
Diagnosis of Arterial Blockage
Physicians can make a diagnosis by listening to the symptoms described by the patient and by determining if the pulse in the arteries of the feet is diminished. Further tests may include:
- Ultrasound, which is a test that uses sound waves to produce an image of blood flow through the arteries.
- Arteriography, is a diagnostic test that may be performed if the condition is serious enough to warrant a Trans–catheter Intervention or Surgery. The test, which uses a harmless dye injected into the arteries, allowing physicians to see the location and severity of the blockage.
When the blockages are not severe, this form of PVD is often controlled by losing weight, quitting smoking, and by following a regular exercise program that has been approved by your physician. A Trans–catheter Intervention (Balloon Angioplasty) may be necessary for a severely blocked artery that is causing pain or other symptoms.
Your doctor may also recommend a Peripheral Vascular Bypass. This procedure involves re–routing blood flow around one or more narrowed vessels. Through an incision in the arm, leg, or abdomen, either an artificial vessel or one of your own veins (called a Graft) is used to Bypass the blockage. The surgeon connects the graft at points above and below the blockage to restore blood flow.
Aortic Aneurysms
An Aneurysm is the bulging out of the wall of a weakened blood vessel. If the bulging stretches the vessel wall to its limit, the vessel may rupture.
An Aneurysm in the aortic artery (the artery that carries blood from the heart to the rest of the body) is called an Aortic Aneurysm. An Aortic Aneurysm may be located in the abdominal area, below the renal arteries, or in the chest. The bursting of this main artery due to an aneurysm can be fatal if it is not treated in a timely fashion.
Causes of Aortic Aneurysms
Any condition that causes the arterial walls to deteriorate can lead to an Aneurysm. Arteriosclerosis (a build–up of plaque in the arteries that weakens the walls of blood vessels), high blood pressure, and smoking are risk factors. Penetrating wounds, injuries, or infections also can cause blood vessels to bulge. In some cases, the condition may be a Congenital (inherited) abnormality. High–risk candidates include people who have an inherited disease such as Marfan syndrome, a degenerative connective tissue condition characterized by long bones and hyperflexible joints.
Symptoms of Aortic Aneurysms
Aortic aneurysms may cause shortness of breath, hoarseness, backache, or pain in the left shoulder or between the shoulder blades. Abdominal Aortic Aneurysms may cause abdominal pain or tenderness, loss of appetite, and nausea.
Diagnosis of Aortic Aneurysms
Aneurysms can be detected by a physical examination, on a basic chest or abdominal X–ray, or by using Ultrasound. The size and location can be estimated through Ultrasonography or Radiological Imaging, such as Arteriography, Magnetic Resonance Imaging (MRI), and Computed Tomography (CAT) Scanning.
Treatment of Aortic Aneurysms
Treatment depends on the size and location of the Aneurysm and the patient’s overall health. Aneurysms in the ascending aorta (in the upper chest) are usually operated on immediately. Aneurysms in the descending (lower chest) and abdominal portions of the aorta may not be as life threatening. Aneurysms in these locations are monitored regularly. If they reach about 5 cm (almost 2”) in diameter, continue to enlarge, or become symptomatic, surgery is generally indicated. For Aortic Aneurysms or Aneurysms that occur in the Peripheral vessels, surgery involves either removing the aneurysm or relining or replacing the weakened section of the aorta with an artificial tube (Grafting).
For patients with smaller or stable aneurysms in the descending aorta or abdominal parts of the aorta – those farthest from the heart, physicians usually monitor patients to follow the growth of the aneurysm. If growth is minimal, patients may live with the aneurysm for years. In patients where the risk of surgery may be greater than the risk of the aneurysm itself, physicians may also prescribe medications, especially hypertension–reducing drugs and Beta blocker therapy to lower blood pressure and relieve stress on the aortic walls.
Buerger’s Disease
Buerger’s disease is a smoking–related disease that causes inflammation of small and medium–sized arteries (and sometimes veins) in the feet and legs. This rare disorder, which causes severe constriction of the peripheral vessels, is more common in men, especially smokers aged 20 to 40. Smoking causes constriction of the blood vessels in everyone who smokes, but persons with Buerger’s disease experience so much narrowing that Ischemia (lack of oxygen) or Necrosis (tissue death) may result.
The symptoms may vary in intensity, but the condition commonly produces tender, swollen areas over the inflamed vessels, followed by coldness of the feet and hands. Intermittent Claudication (pain in the legs during walking) may occur due to arterial blockage. The most serious cases sometimes result in Gangrene and Amputation of the fingers and toes. Persons with Buerger’s disease must stop smoking completely, this usually produces an immediate improvement in circulation.
Raynaud’s Phenomenon
Raynaud’s phenomenon, which occurs more often in women, is a circulation disorder that involves severe constriction or spasm of the arteries in the fingers and toes when they are exposed to cold temperatures, smoking, or emotional distress.
Often, the cause of Raynaud’s phenomenon is unknown. Sometimes, it is a complication of other conditions, such as connective tissue disease, trauma, or disease of the Endocrine glands or Central nervous system. Persons with the disorder may feel numbness or tingling in the fingers and toes, and may also notice a pale or bluish discoloration of the skin followed by reddening in the affected areas. Attacks may last from a few minutes to several hours and are usually treated with gradual warming of the fingers and toes to restore circulation. Therapy may also include analgesics, calcium channel blockers, quitting smoking, and avoiding cold temperatures and emotional upsets.
