Peripheral Artery Disease and other circulatory problems

A circulatory disorder affects the heart, blood vessels and/or blood. They usually are the result of reduced blood flow due to the narrowing of the arteries. This means that less oxygen is transported to the organs/body.

Diagnosis

Peripheral artery disease (PAD) is the narrowing of the outer arteries (stenosis). As blood flows through the arteries it can leave plaque on the inside of the hollow middle that can build up over time and cause the artery to narrow. Those most likely to be affected are smokers, those with high blood pressure and cholesterol, those who are overweight and have a diet that is rich in fat. The most common symptom of PAD is pain in the lower leg or foot. This is due to a lack of sufficient oxygen and nutrients being transported to all areas of the lower limb. Insufficient oxygen means the structures are unable to function properly. To diagnose PAD a range of tests and a personal medical history is needed. A physical exam is used to check the pulses in the leg arteries. An ankle-brachial index test can also be used to compare blood pressure in the ankle and blood pressure in the arm. A Doppler ultrasound can also be used to assess blood flow in the major arteries. This is useful as the practitioner can identify where a blockage is and how severe it is. An arteriogram (an invasive test) can also be used – this is where dye is injected into the arteries and an x-ray shows the condition of the arteries. 

Treatment of PAD

Treatment of PAD can be conservative or through surgical intervention. Conservative measures include managing a patient’s diet and high blood pressure, using platelet medication to prevent blood clots forming on the plaque build up and medication to relax the blood vessels making it easier for the blood to flow through. Surgical intervention involves attaching a graft above the narrowed area which gives a new route for the blood to travel to the lower limb.

Deep Vein Thrombosis (DVT)

Deep Vein Thrombosis (DVT) is the formation of a blood clot. It usually affects the large veins in the legs such as the femoral vein, popliteal vein or iliofemoral vein. DVT can happen when blood circulation in the legs slows down, for example, when someone is inactive for a period of time or ill. The blood pools when a vein is damaged or in people who are more likely for their blood to clot. Those at risk for DVT include smokers, older people, overweight people, those on the contraceptive pill or on hormone replacement therapy. It can occur without any symptoms but when they do occur they may include a dull ache in the affected leg, pain, swelling, warmth and redness. Diagnosis for DVT  requires a detailed medical history and a physical exam to check for swelling, pain or redness. Other tests such as blood tests, an ultrasound or MRI (Magnetic Resonance Imaging) can be used. Treatment depends on the severity  and history of the patient. The most common treatment is blood thinners (anti coagulants) such as warfarin or heparin. These make it more difficult  for the blood to clot. Thrombolytics can also be used to break up a clot. Where conservative treatments have not been effective a venous thrombectomy may be required to remove a clot.

DVT  can cause different complications, the most serious being a pulmonary embolism. This is when a blood clot goes in the blood to the lungs. Once there it can block the pulmonary artery meaning that blood is unable to reach the lungs. This can be fatal. 

Veins carry deoxygenated blood to the heart and lungs. They have valves to prevent the backflow of blood. Sometimes the valves become permanently damaged thus reducing the ability of the veins to return blood to the heart efficiently. Varicose veins are formed when the normal blood flow in the veins is disrupted due to a damaged valve. Blood is able to flow backwards in the vein which causes an overload of pressure on the vein. This leads to the veins widening meaning that the valve cannot close properly, the veins become enlarged and start to bulge. Varicose veins are commonly found in the superficial veins of the legs as they are under more pressure when a person is standing.

   There are different types of varicose veins – reticular, red and sometimes appear ‘grouped’ together. Trunk varicose veins are near the skin’s surface and look thick and twisted. Telangiectasis/thread veins are small clusters of blue or red lines that do not bulge. Those who experience symptoms report aching and heaviness in the legs, cramping, itching and swelling.

   Treatment of varicose veins is lifestyle changes such as weight loss, increasing muscle tone in the lower legs and leading an active lifestyle. A more invasive approach can be taken if the symptoms are severe, for example, laser therapy, ambulatory vein surgery or vein stripping.