Perpheral Vascular Disease
Perpheral vascular disease (PVD) is a general term that describes the range of conditions that affects arteries caused by atherosclerosis. This is the disease your granny would have called “hardening of the arteries” because often the arteries become narrowed and blocked. However, the same disease can result in the walls of the artery degenerating with weakening of the vessel wall resulting in an aneurysm. As the arteries narrow the blood supply to a particular organ or limb becomes impaired resulting in problems. In the heart this can lead to chest pains (angina) and eventually a heart attack. Blocked arteries in the legs cause cramp like pains with walking ( claudication) and this can lead to gangrene in severe cases. If the carotid arteries in the neck start to furr up then a stroke may occur.
Peripheral vascular disease affecting the legs is more common than you may think. Up to 20% of the population over 60 years of age have PVD, although only a quarter complain of symptoms. It is particularly common in smokers (they never mention that on the fag packets), diabetics and individuals with high blood pressure and high cholesterol. As the arteries furr up most patients experience cramp like pain in the calf or thigh muscles that forces them to stop walking, this is called intermittant claudication, named after the Roman Emperor Claudius who allegedly used to limp. Most patients with claudication rarely need surgical intervention. Simple measures such as quitting smoking, treating high blood pressure and cholesterol and good control of blood sugar in diabetics plus excercise are usually all that is required. In certain cases it may be feasable to dilate or widen the affected vessel using a balloon, this procedure is called angioplasty. On occasion the vessel may require metal cage reinforcement to prevent it from collapsing again, this is the purpose of a stent. If the arterial disease is extensive, the blood supply to the leg may reach critical levels that there is insufficient flow to keep the tissues alive, this results in the extremities such as the toes dying and becoming gangrenous. This is usually where we come in. Sometimes it is possible to save a foot or leg by performing a bypass operation. The blocked artery is bypassed usually by taking a segment of one of the patient’s vein (there are plenty, just look at your own arm) and plumbing it in above and below the blockage. Alternatively a PTFE graft ( plastic tube) can be used. Unfortunately and all too often many of our patients have severe and untreatable disease particularly the diabetics or they continue to smoke and the leg ends up in the dustbin – amputation