Arterial and venous diseases of the legs are common in the United States. Peripheral arterial disease (PAD) afflicts approximately 8-12 million Americans according to the American Heart Association. In fact approximately 1 in 20 individuals over the age of 50 have PAD. Venous diseases affect greater than 80 million Americans according to the American College of Phlebology.
Peripheral Arterial Disease (PAD)
PAD is the development of atherosclerotic plaque in the lining of the arteries which bring oxygen enriched blood to the various organs of the body. The legs are one of the most common sites for plaque build-up and associated circulatory problems. The development of fatty deposits in the arteries of the legs often leads to limited circulation which often leads to leg pain. In more serious situations PAD can cause infections of the legs and in the most serious cases can risk the loss of limbs. The same risk factors which increase an individuals risk for coronary artery disease increase the risk to develop PAD. These risk factors include hypertension, family history, cholesterol abnormalities, diabetes and tobacco use – diabetes and tobacco use seem to impart an even higher risk to for the development of PAD then other risk factors.
Often leg, hip, and buttock pain are the first signs of PAD. A simple screening test called an ankle brachial index (ABI) can detect the presence of PAD. An ABI test is a measurement of blood pressure readings in the arm and legs and can be performed in most doctors offices. More advanced testing, such as an MRI/MRA, CT scan or angiogram may be needed to better define the degree of PAD present.
Treatment of risk factors and lifestyle changes (such as regular exercise and following a low fat diet) are key to the long-term treatment of PAD. These interventions are also key to reducing the risk of suffering a stroke and reducing the risk for developing coronary artery disease. Individuals with PAD are at significantly higher risk to develop heart disease and to suffer a stroke. Some reports have shown that 50-60% of individuals with PAD also have coronary artery disease (heart disease). There are some medications (such as Cilostazal/Pletal) which may increase exercise capabilities for those suffering from symptoms due to PAD; but at times surgery or minimally invasive interventions are needed to treat severe blockages. Minimally invasive treatments include angioplasty, laser and stent procedures which open severe blockages in the legs. These procedures are performed similar to coronary interventions (heart angioplasty procedures).
Venous Diseases Of the Legs
Venous diseases of the legs are common in the United States. Individuals with venous disease range from those with small vein diseases (spider and reticular veins) to those with deep vein thrombosis and superficial venous reflux – typically of the large superficial veins such as the Greater Saphenous vein. Venous reflux is the back-flow of blood in the legs because of poorly functioning valves in leg veins. The numerous one way valves in leg veins are present to assure venous blood travels back to the heart. When these valves malfunction the veins in the legs become enlarged and dilate – leading to pain, swelling and discoloration of the skin.
In more serious cases pressure ulcers can develop. Venous diseases of the legs affect women more often than men (due to hormones). It occurs more frequently in obese individuals and those with occupations requiring long periods of standing.
Other factors, which can increase the risk to develop venous disease include leg injuries, aging, family history and pregnancy. Diagnosis of venous disease involves a physical exam of the legs often followed by a non-invasive ultrasound evaluation. Conservative measures to treat venous disease of the legs inclues the use of graduated compression stockings. Surgical options include vein stripping and ligation procedures. Minimally invasive procedures to treat venous reflux includes sclerotherapy (with ultrasounds guidance). Sclerotherapy is a process by which veins are injected with a sclerosing agent which causes the wall of the veins to become irritated. This irritation or damage leads to the veins collapsing and becoming absorbed by the body. Minimally invasive procedures such as laser and radiofrequency procedures are commonly performed to treat reflux of the larger superficial veins. These are low risk and affective treatments which cause diseased veins to collapse; and ultimately absorbed by the body. When diseased veins are eliminated then healthier veins take up their duties which provides for more robust blood return to the heart. Improved blood return to the heart typically leads to significant improvement in leg edema, pain and discoloration.