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Electrophysiology
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Lower Extremity Arterial
Occlusive Disease What is Lower Extremity Arterial Occlusive Disease?
Atherosclerosis, or
hardening of the arteries, is caused by the accumulation of a fatty substance
called plaque within the walls of arteries. Thickening of the arterial
wall causes a narrowing of the channel blood takes through the artery,
producing a "stenosis." Atherosclerosis is a systemic disease;
it affects arteries throughout the body and is a major cause of heart
attack and stroke. When it involves the arteries in the legs it is called
lower extremity arterial occlusive disease. How is Lower Extremity Arterial Occlusive Disease
Diagnosed?
The symptoms of lower
extremity arterial occlusive disease include:
Claudication is the
most common manifestation of lower extremity arterial occlusive disease.
10% of Americans over the age of 70 have claudication. The symptoms can
be mild or very disabling (inability to walk 2 blocks before developing
pain). Only approximately one third of people with claudication progress
to the point where they need surgery or another procedure to prevent limb
loss (amputation). Pain in the legs at
rest, wounds that will not heal, or persistent numbness or weakness are
symptoms of worsening arterial disease. Imaging tests such
as angiography may also be necessary to determine the location and the
extent of the arterial narrowing (stenosis) in the legs.
How is Lower Extremity Arterial Occlusive Disease
Treated?
If symptoms are mild
to moderate, the disease can be well managed by lifestyle changes such
as a smoking cessation, a dedicated walking program, and management of
risk factors such as diabetes, high blood pressure, and high cholesterol.
The walking program, if continued for three to four months, can increase
walking distance in one-third of people. It entails walking 30 minutes
per day every day, walking to the point of discomfort, resting until the
discomfort resolves and then walking again. Blood-thinning drugs or other
kinds of medication may also helpful in increasing walking distance. In some cases the arterial
stenosis can be treated using minimally invasive procedures such as angioplasty
and stenting to improve blood supply to the extremity. If the artery is
blocked completely, arterial bypass surgery may necessary in order to
restore blood flow. Treatment Options
An angiogram helps your doctor to plan the treatment by providing a "road map" of the disease. An angiogram is a radiologic procedure performed by inserting a small tube (catheter) into the femoral artery in the groin. Contrast (x-ray "dye") is injected into the catheter and it outlines the blood vessels and shows the narrowed regions. Sometimes an angioplasty can be performed at the same time. This involves maneuvering a catheter with a balloon at its tip into the narrowed portion of the artery. The balloon is then inflated gently to stretch the narrowed region. Often a metal tube (stent) is inserted to keep the artery wall open after angioplasty. Not all arterial disease is amenable to angioplasty. For instance, angioplasty works best on large blood vessels (those in the pelvis and upper thigh) and less well on the smaller vessels in the calf. It works best for very focal lesions, and not so well for arteries that are diffusely narrowed or occluded. In many
instances, surgery is the best treatment. Surgery generally involves either
removing the plaque from the diseased artery or bypassing the diseased
artery. Bypass means using your own vein or a fabric tube to create a
detour path around the narrowed or blocked artery. These options are reviewed
after the angiogram. Treatment for every patient is individualized because
each person's medical condition and pattern of disease is slightly different. |
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