Peripheral vascular disease afflicts millions of Americans yearly. Approximately 80 million Americans suffer with venous insufficiency and approximately eight million Americans are afflicted with peripheral arterial disease- narrowed/blocked arteries in the legs. Venous disease can cause significant leg swelling, pain and ulcers while peripheral arterial disease can progress to severe narrowings/blockages in leg arteries- which can cause leg pain with walking as well as poorly healing leg and foot infections.
Approximately 12-20% of individuals 65 years of age or older have peripheral arterial disease while 43% of men and 72% of women over the age of 60 have venous disease. The same risk factors that increase the risk for suffering a stroke and developing coronary atherosclerosis increase the risk for developing peripheral arterial disease (PAD): plaque build-up/narrowing in the legs, and kidney and carotid arteries. In fact, individuals with PAD are four to five times more likely to suffer a stroke or heart attack.  Risk factors for developing PAD include obesity, hypertension, advanced age, diabetes, tobacco consumption and a family history of vascular disease.
Risk factor modifications are a key weapon in the treatment and prevention of PAD. These modifications involve changes in diet, weight loss and increased exercise. It is also very important to identify and treat individuals with hypertension, elevated lipid levels and diabetes. Smoking cessation is also an integral aspect in treating those with or those at risk for PAD.
Diseases of the veins (which often leads to leg swelling, pain and varicose veins) occur most frequently in individuals with a family history, who have standing occupations and in the elderly.
Venous disease most often is due to venous reflux or veins that do not adequately return blood from the legs back to the heart. This is due to leaking of the small one way valves which exist in all the veins in the body. This leaking often leads to swelling, pain and in some cases poorly healing ulcers.
Diagnosing Peripheral Arterial and Venous Disease is often a simple but overlooked evaluation. The most common symptom and the first clue toward the existence of PAD is leg pain while walking; however, approximately 50% of individuals with PAD do not have classic leg pain symptoms. The first step in diagnosing PAD is a simple blood pressure evaluation of the arms and legs known as an ankle-brachial index (ABI).  This test is quite accurate at diagnosing PAD. ABI’s and ultrasound studies that can identify blockages can easily be performed in an office setting. These studies and certain types of MRI/MRA and CT scan studies are used to identify blocked or narrowed arteries.
Venous disease can be evaluated with a simple ultrasound/Doppler evaluation. This type of study can evaluate whether a clot (deep vein thrombosis) is present and whether venous reflux exists. Ultrasound evaluations are safe and painless.
When severe PAD is the cause of significant leg pain or compromises flow to the kidneys and brain, medical management is often not sufficient. Often minimally invasive procedures, similar to angioplasty/stent procedures used to clear blocked arteries in the heart, are able to clear blocked arteries in the legs, kidneys and carotid arteries. Typically, small wires are used to cross narrowed arteries and then various techniques such as lasers, balloons and stents are used to clear the blockages. These minimally invasive techniques allow for quick recovery and often allow patients to be sent home the day of their procedure. These techniques can often decrease the risk of stroke and eliminate leg pains caused by restrictive blood flow. In some instances these clearing procedures can reduce the risk of kidney failure and save limbs from amputation.
When appropriate venous disease can be treated with minimally invasive procedures to treat leaky veins- venous reflux. These procedures are typically completed in the office and with minimal recovery and minimal discomfort. Typically patients can drive home from their procedures and have excellent long term relief from leg pain and swelling.