Strong Heart and Vascular Center

Division of Vascular Surgery

Lower Extremity Occlusive Disease

Diagnosis

Arteriosclerosis, or "hardening of the arteries" can affect any artery in the body. When it affects the arteries supplying the legs, it is referred to as peripheral arlenal disease ("PAD"). The build-up of cholesterol, calcium, and other materials causes a narrowing in the artery, which restricts the flow of blood. Many persons have blockage without symptoms. When mild, such narrowing can cause pain in large muscle groups with exercise ("claudication") but, if more severe, pain at rest or even tissue breakdown (ulcers, infection, or dry gangrene) can occur. In general, although each circumstance differs, conservative therapy is recommended for mild claudication while more aggressive intervention is needed for symptoms at rest. The initial evaluation is directed toward defining the degree of disability this blockage is causing, and determining in a general sense where the blockage is. Both factors together, along with overall health, are used to formulate a plan.

Patients with blockage in the aorta and iliac arteries, above the groins, often have weakness or pain in their thighs and buttocks with exercise, and males can have impotence. Patients with blockage in the legs, below the groins, often have weakness or pain in their calves with exercise. Patients with tissue breakdown or pain at rest can have blockages in several places.

Today's Visit

We will perform ultrasound testing if data do not already exist. We will also discuss your medical history, the details of your situation, and options for treatment in better detail.

What You Can Do

If you smoke, it is critically important to quit smoking. It is also important to be taking an antiplatelet agent such as aspirin or an alternative. It is also important to keep your weight and blood pressure under control, get regular exercise, and practice good foot care and daily inspection.

Nonsurgical Treatment

If symptoms are mild, conservative care (at times supplemented with medication) is usually recommended. If more significant, consideration is given to stenting or surgery. In this case, an angiogram is needed. If a blockage is found that can be fixed with a stent, this is usually possible to perform at the time of the angiogram.

Surgery

If stenting is not possible, surgery may be needed. Several options are available, and multiple factors determine which is the recommended repair technique for each individual patient. Your surgeon will discuss the pros and cons of each option with you before a decision is made.

After surgery

If all goes well, you will be in the hospital approximately 2 to 4 days, depending on the surgical technique. You will be able to get out of bed the day after surgery and gradually resume normal activities. You should be fairly independent with your personal care by the time you go home, but should plan to have someone at home with you to help with meals, house keeping, grocery shopping, and so on. You may shower and wash your wounds after all dressings are off, unless other instructions have been given to you. Home nursing or aide care is sometimes needed and will be arranged before discharge. You will see your surgeon 2 to 4 weeks after discharge for routine follow-up. Although everyone is different, full recovery typically takes 1 to 3 months.