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Varicose Veins

Veins are present in a wide variety of sizes (ranging from microscopic, up to 2-3cm diameter in the torso). Although the diameter and precise anatomic location of veins has some degree of variability, veins in the legs can generally be divided into two categories (“superficial” veins and “deep” veins). The “superficial” veins are located relatively close to the skin (or within a few centimeters of the skin surface), whereas the “deep” veins are more centrally located in the deep muscular compartments of the legs.

Although less common than valve dysfunction, other potential causes of increased pressure within the veins in the lower leg can can occur when upstream veins become clogged with clot (thrombus), or narrowed due to scar tissue. The relationship between a venous blood clot and the current (or ultimate) effect of venous blood-flow is complex. Sometimes blood clots can completely obstruct venous blood flow, and on other occasions blood clots are only “partially occlusive”, in which case blood can continue to flow around the clot.

The catch-all medical name for condition where the veins in the lower part of the leg are under increased pressure is “chronic venous insufficiency” (CVI).

Symptoms
Diagnostic Workup
Treatment

Increased pressure within the leg veins associated with chronic venous insufficiency may result in a variety of symptoms including heaviness, tiredness, aching, itching, or pain.

Swelling in the lower part of the leg or the ankle is common. Symptoms can occur in one or both legs.

Spider veins and varicose veins can be asymptomatic, but may result in symptoms of burning, tingling, itching or localized discomfort. In addition spider veins and varicose veins may be of cosmetic concern to many patients.

Leg symptoms secondary to venous insufficiency are generally exacerbated by prolonged standing (or sitting), and are relieved by elevation of the leg(s).

In advanced cases of venous insufficiency the skin around the ankle may become stained a brown color, or may develop progressive leathery thickening. In severe cases wounds or ulcers can also occur

Patients with prominent varicose veins or symptoms suggestive of venous insufficiency merit evaluation by a vascular specialist.

A review of past medical and surgical conditions, current symptoms, medications, and physical examination are routinely performed. The decision about whether to perform adjunctive diagnostic testing is based upon the patients symptoms, and exam findings.

The most commonly used test to evaluate the structure and function of the veins in the legs is “duplex ultrasound”. Duplex ultrasound is a painless study that involves using a hand-held ultrasound probe to shine high-frequency sound-waves through the skin, allowing visualization of the leg veins. The duplex study is able to visualize both the “superficial veins” and the “deep veins” in the legs. If present, abnormalities of valve function and venous blood clots are readily identifiable.

On an infrequent basis additional diagnostic tests such as venogram (injection of dye into the vein supplemented by X-ray imaging), or CT-scanning are required.

CLOSUREFAST™ PROCEDURE

VENESEAL™ PROCEDURE

Symptoms

Increased pressure within the leg veins associated with chronic venous insufficiency may result in a variety of symptoms including heaviness, tiredness, aching, itching, or pain.

Swelling in the lower part of the leg or the ankle is common. Symptoms can occur in one or both legs.

Spider veins and varicose veins can be asymptomatic, but may result in symptoms of burning, tingling, itching or localized discomfort. In addition spider veins and varicose veins may be of cosmetic concern to many patients.

Leg symptoms secondary to venous insufficiency are generally exacerbated by prolonged standing (or sitting), and are relieved by elevation of the leg(s).

In advanced cases of venous insufficiency the skin around the ankle may become stained a brown color, or may develop progressive leathery thickening. In severe cases wounds or ulcers can also occur

Diagnostic Workup

Patients with prominent varicose veins or symptoms suggestive of venous insufficiency merit evaluation by a vascular specialist.

A review of past medical and surgical conditions, current symptoms, medications, and physical examination are routinely performed. The decision about whether to perform adjunctive diagnostic testing is based upon the patients symptoms, and exam findings.

The most commonly used test to evaluate the structure and function of the veins in the legs is “duplex ultrasound”. Duplex ultrasound is a painless study that involves using a hand-held ultrasound probe to shine high-frequency sound-waves through the skin, allowing visualization of the leg veins. The duplex study is able to visualize both the “superficial veins” and the “deep veins” in the legs. If present, abnormalities of valve function and venous blood clots are readily identifiable.

On an infrequent basis additional diagnostic tests such as venogram (injection of dye into the vein supplemented by X-ray imaging), or CT-scanning are required.

Treatment

CLOSUREFAST™ PROCEDURE

VENESEAL™ PROCEDURE

Spider Veins & Cosmetic Issues

Tiny veins (less than 1mm in diameter) visible on the skin surface are commonly called “spider veins”. The name “spider vein“ refers to the web-like appearance of these veins when clustered together. Most of the time spider veins are asymptomatic (or minimally symptomatic) and are primarily of cosmetic concern. To schedule your cosmetic consultation, click here.

Typically patients with spider veins can be reassured that their problem is not limb-threatening. Consideration can be given to cosmetic therapies such as injection sclerotherapy or transcutaneous laser.

Not infrequently, patients with spider veins will report localized symptoms of pain, itching, burning, or tenderness. Isolated (or scattered) spider veins typically represent a localized problem at the level of the skin. In this situation underlying structural vein problems are unlikely, and it is not necessary to perform additional diagnostic testing.

In patients with extensive symptomatic spider veins (especially if larger varicose veins are also present) it is not unreasonable to perform duplex ultrasound testing on the leg(s) to evaluate for underlying structural vein problems, that may be the nidus of the patient’s symptoms.

Symptoms
Diagnostic Workup
Treatment

Although most patients with spider veins report no significant symptoms some patients with spider veins do report symptoms of tingling, burning or localized discomfort.

Spider veins are more likely to be symptomatic when multiple spider veins are present when the spider veins are closely clustered,  or problems are present in the larger underlying veins.

Most patients with isolated spider veins do not require extensive diagnostic testing.

In some situations (especially if the spider veins are combined with larger varicose veins or if significant symptoms are present) diagnostic ultrasound testing may be indicated.

At Vascular Solutions spider veins are treated with sclerotherapy or laser leg vein treatment.

Sclerotherapy involves injection of medicine into skin surface veins that causes the veins to contract and fade over time.

Sclerotherapy is commonly performed for cosmetic reasons, but sometimes sclerotherapy can be used to help alleviate symptoms of itching, burning and discomfort.

Sclerotherapy is ideally suited to veins measuring 1-3mm in diameter, but can also treat larger veins. Sclerotherapy can also treat tiny veins (measuring <1mm in diameter) but in this situation cosmetic laser treatment may be a better option.

Laser leg vein treatment is a purely cosmetic procedure that uses a hand-held laser device to eliminate small skin surface veins.

Laser leg vein treatment can be used to target any skin surface vein measuring less than 3mm diameter, but is ideal for tiny veins less than 1mm diameter. Cosmetic laser leg vein treatment is not indicated for the treatment of varicose veins, or any vein larger than 3mm in diameter.

Symptoms

Although most patients with spider veins report no significant symptoms some patients with spider veins do report symptoms of tingling, burning or localized discomfort.

Spider veins are more likely to be symptomatic when multiple spider veins are present when the spider veins are closely clustered,  or problems are present in the larger underlying veins.

Diagnostic Workup

Most patients with isolated spider veins do not require extensive diagnostic testing.

In some situations (especially if the spider veins are combined with larger varicose veins or if significant symptoms are present) diagnostic ultrasound testing may be indicated.

Treatment

At Vascular Solutions spider veins are treated with sclerotherapy or laser leg vein treatment.

Sclerotherapy involves injection of medicine into skin surface veins that causes the veins to contract and fade over time.

Sclerotherapy is commonly performed for cosmetic reasons, but sometimes sclerotherapy can be used to help alleviate symptoms of itching, burning and discomfort.

Sclerotherapy is ideally suited to veins measuring 1-3mm in diameter, but can also treat larger veins. Sclerotherapy can also treat tiny veins (measuring <1mm in diameter) but in this situation cosmetic laser treatment may be a better option.

Laser leg vein treatment is a purely cosmetic procedure that uses a hand-held laser device to eliminate small skin surface veins.

Laser leg vein treatment can be used to target any skin surface vein measuring less than 3mm diameter, but is ideal for tiny veins less than 1mm diameter. Cosmetic laser leg vein treatment is not indicated for the treatment of varicose veins, or any vein larger than 3mm in diameter.

Deep Vein Thrombosis

Although there are deep veins in both the legs and the arms blood clots more commonly occur in the legs.

Risk factors for deep vein thrombosis include prolonged immobility (such as long car rides or plane travel), traumatic injury (example; surgical intervention), and a variety of hematologic conditions that result in a propensity towards clot formation. Some of the hematologic conditions that increase the risk of blood clot are genetic in nature and can be evaluated for with genetic testing.

Symptoms
Diagnostic Workup
Treatment

When blood clot forms within a deep vein the vein can become partially or completely “clogged”.   This obstruction to venous blood flow can result in increased pressure within tributary veins that are trying to flow into this pipe. In turn, this increased pressure within the more peripheral veins results in leakage of fluid from the veins into the tissues under the skin, and can manifest as leg swelling.

Leg swelling is the most common symptoms of deep vein thrombosis. In addition to leg swelling many patients report pain, aching discomfort, or tenderness in the area where the blood clot is formed. This pain and tenderness is likely related to inflammation in and around the vein wall as the body mounts a response to try and clear the blood clot.

Occasionally blood clot(s) in the deep veins in the legs can fragment and travel to the heart and lungs. This condition is known as pulmonary embolism.   Common symptoms of pulmonary embolism include chest pain and shortness of breath.  Occasionally patients with pulmonary embolism will report that they have been coughing up small amounts of blood.

Only a small percentage of patients with deep vein thrombosis will sustain a pulmonary embolism however when the condition occurs it can be serious and life-threatening.

The most common diagnostic test used to confirm or exclude the presence of blood clot(s) is ultrasound testing.   Modern ultrasound machines can not only detect the presence of blood clot within a vein but can also accurately evaluate flow of blood through (and around) the area of blood clot.

The management of blood clot in the deep veins is guided by a patient’s clinical presentation,  physical examination findings,  and ultrasound findings.

In the majority of cases patients with a fresh blood clots in the legs are treated by using blood thinner medications for a variable period of time.  The purpose of blood thinning medications is to prevent extension of the blood clot into adjacent veins, prevent additional blood clots from forming, and allow the body to start the healing process.

In cases of extensive fresh blood clot patients may be a candidate for procedures designed to more aggressively bust-up (dissolve) the blood clot.  The medical name for these procedures is pharmaco-mechanical thrombolysis (or venous thrombolysis). These procedures typically involve temporary insertion of a thin piece of tubing into the vein that allows strong clot-busting medication to be slowly trickled into the vein. There are several devices that can be used augment this clot-busting process.

Symptoms

When blood clot forms within a deep vein the vein can become partially or completely “clogged”.   This obstruction to venous blood flow can result in increased pressure within tributary veins that are trying to flow into this pipe. In turn, this increased pressure within the more peripheral veins results in leakage of fluid from the veins into the tissues under the skin, and can manifest as leg swelling.

Leg swelling is the most common symptoms of deep vein thrombosis. In addition to leg swelling many patients report pain, aching discomfort, or tenderness in the area where the blood clot is formed. This pain and tenderness is likely related to inflammation in and around the vein wall as the body mounts a response to try and clear the blood clot.

Occasionally blood clot(s) in the deep veins in the legs can fragment and travel to the heart and lungs. This condition is known as pulmonary embolism.   Common symptoms of pulmonary embolism include chest pain and shortness of breath.  Occasionally patients with pulmonary embolism will report that they have been coughing up small amounts of blood.

Only a small percentage of patients with deep vein thrombosis will sustain a pulmonary embolism however when the condition occurs it can be serious and life-threatening.

Diagnostic Workup

The most common diagnostic test used to confirm or exclude the presence of blood clot(s) is ultrasound testing.   Modern ultrasound machines can not only detect the presence of blood clot within a vein but can also accurately evaluate flow of blood through (and around) the area of blood clot.

Treatment

The management of blood clot in the deep veins is guided by a patient’s clinical presentation,  physical examination findings,  and ultrasound findings.

In the majority of cases patients with a fresh blood clots in the legs are treated by using blood thinner medications for a variable period of time.  The purpose of blood thinning medications is to prevent extension of the blood clot into adjacent veins, prevent additional blood clots from forming, and allow the body to start the healing process.

In cases of extensive fresh blood clot patients may be a candidate for procedures designed to more aggressively bust-up (dissolve) the blood clot.  The medical name for these procedures is pharmaco-mechanical thrombolysis (or venous thrombolysis). These procedures typically involve temporary insertion of a thin piece of tubing into the vein that allows strong clot-busting medication to be slowly trickled into the vein. There are several devices that can be used augment this clot-busting process.

Lower Extremity Edema

Lower extremity swelling, also known as edema, occurs when fluid accumulates in the legs. A surprisingly wide variety of medical conditions including disorders of the following:

  • Heart
  • Kidneys
  • Liver
  • Intestinal tract
  • Muscles
  • Joints
  • Immune system
  • Lymphatic system
  • Blood vessels

These types of disorders can result in lower extremity swelling (edema).

Vein problems are a common cause of leg swelling. In many patients leg swelling may be the only symptom of venous disease.

Symptoms
Diagnostic Workup
Treatment

Although lower extremity swelling (edema) can be asymptomatic, many patients report symptoms of:

  • heaviness
  • tiredness
  • aching discomfort
  • pain

Symptoms are typically worse towards the end of the day, and tend to be exacerbated by long periods of sitting or standing.

The overwhelming majority of patients with lower extremity limb swelling will benefit from evaluation with duplex ultrasound. The purpose of this test is to confirm or exclude the presence of vein problems that.

Occasionally vein problems in the abdomen and pelvis can cause leg swelling. In this situation, CAT-scan imaging of the abdomen may be necessary.

On a case-by-case basis additional diagnostic testing evaluating other organ systems (such as heart function, or kidney function need to be coordinated). Cross-referral to other medical specialists is utilized when appropriate.

Successful treatment of lower extremity swelling (“edema”) requires accurate diagnosis of the underlying disease process.

If “non-vascular” causes of limb pain are diagnosed then management is directed towards that condition.

It is not uncommon to encounter patients who have been dealing with swelling for months (or even years) before seeking medical attention.  If underlying vein problems are identified the condition may be readily treatable/reversible.

Symptoms

Although lower extremity swelling (edema) can be asymptomatic, many patients report symptoms of:

  • heaviness
  • tiredness
  • aching discomfort
  • pain

Symptoms are typically worse towards the end of the day, and tend to be exacerbated by long periods of sitting or standing.

Diagnostic Workup

The overwhelming majority of patients with lower extremity limb swelling will benefit from evaluation with duplex ultrasound. The purpose of this test is to confirm or exclude the presence of vein problems that.

Occasionally vein problems in the abdomen and pelvis can cause leg swelling. In this situation, CAT-scan imaging of the abdomen may be necessary.

On a case-by-case basis additional diagnostic testing evaluating other organ systems (such as heart function, or kidney function need to be coordinated). Cross-referral to other medical specialists is utilized when appropriate.

Treatment

Successful treatment of lower extremity swelling (“edema”) requires accurate diagnosis of the underlying disease process.

If “non-vascular” causes of limb pain are diagnosed then management is directed towards that condition.

It is not uncommon to encounter patients who have been dealing with swelling for months (or even years) before seeking medical attention.  If underlying vein problems are identified the condition may be readily treatable/reversible.

Lower Extremity Wounds & Ulcers

When traumatic injury occurs the process of wound healing relies on a complex interplay between various body systems (cellular, immune, hematologic and metabolic processes). These complex processes can only occur when there is adequate circulation to the area of injury.

Circulation problems can inhibit the ability of the body to heal an established wound, and in some circumstances circulation problems can be the primary cause of skin breakdown (ulcer).

Peripheral arterial disease (“PAD”) refers to a condition where plaque accumulates within the wall of an artery. Plaque accumulation within an arterial wall is conceptually analogous to a pipe getting “clogged up”. Narrowings and blockages created by the plaque make it difficult for oxygen-rich blood to flow to the lower portions of the legs and feet. Oxygen is a key ingredient for wound healing.

Severe peripheral arterial disease can dramatically compromise the flow of oxygenated blood to the feet and toes. In this situation it is possible for skin breakdown (ulcers) to occur on the feet or toes, simply because there is inadequate oxygenated blood getting to these areas. This situation is often referred to as “critical limb ischemia.”

Symptoms
Diagnostic Workup
Treatment

Skin ulcers caused by arterial problems typically occur on the toes (&/or feet), however, arterial problems can contribute to wounds/ulcers located anywhere on the leg.

Skin ulcers caused by vein problems (“venous-stasis” ulcers) typically occur just above the ankle area, but can also be located anywhere on the lower leg.

Symptom severity is surprisingly disparate for patients with leg ulcers.  Some patients have leg wounds/ulcers that are quite painful, yet other patients have significant size leg wounds/ulcers that are minimally symptomatic.

Regardless of symptom severity, anyone with spontaneous skin breakdown on their toe(s), foot or leg (or wound that has not healed within a few weeks of onset) merits evaluation by a vascular specialist or wound-care expert.

The diagnostic workup of a non-healing wound (or leg ulcer) is initially guided by clinical presentation and physical examination findings.

Detailed assessment of vascular problems can be established using a variety of painless, non-invasive, office-based tests. These office-based tests use a combination of ultrasound (duplex ultrasound) and blood-pressure cuffs to evaluate blood-flow abnormalities.

In some circumstances, additional diagnostic imaging (including X-rays, CT scans or MRI) may be necessary to rule out underlying infection, or further evaluate the blood flow in the arterial or venous systems.

In circumstances where plaque accumulation has resulted in significant reduction of arterial blood flow to the leg(s) there may be options to have procedures done to improve circulation and facilitate wound/ulcer healing.

For most patients with venous leg ulcers, initial therapy often consists of compression bandages and leg elevation to help control the leg swelling.

For patients with leg swelling secondary to venous insufficiency who are intolerant of compression bandages, there may be an option of using pneumatic “edema pumps” to help gently massage the excess fluid from the leg(s).

In circumstances where structural vein problems are confirmed the underlying abnormality can often be fixed using minimally invasive (outpatient) procedures.

Symptoms

Skin ulcers caused by arterial problems typically occur on the toes (&/or feet), however, arterial problems can contribute to wounds/ulcers located anywhere on the leg.

Skin ulcers caused by vein problems (“venous-stasis” ulcers) typically occur just above the ankle area, but can also be located anywhere on the lower leg.

Symptom severity is surprisingly disparate for patients with leg ulcers.  Some patients have leg wounds/ulcers that are quite painful, yet other patients have significant size leg wounds/ulcers that are minimally symptomatic.

Regardless of symptom severity, anyone with spontaneous skin breakdown on their toe(s), foot or leg (or wound that has not healed within a few weeks of onset) merits evaluation by a vascular specialist or wound-care expert.

Diagnostic Workup

The diagnostic workup of a non-healing wound (or leg ulcer) is initially guided by clinical presentation and physical examination findings.

Detailed assessment of vascular problems can be established using a variety of painless, non-invasive, office-based tests. These office-based tests use a combination of ultrasound (duplex ultrasound) and blood-pressure cuffs to evaluate blood-flow abnormalities.

In some circumstances, additional diagnostic imaging (including X-rays, CT scans or MRI) may be necessary to rule out underlying infection, or further evaluate the blood flow in the arterial or venous systems.

Treatment

In circumstances where plaque accumulation has resulted in significant reduction of arterial blood flow to the leg(s) there may be options to have procedures done to improve circulation and facilitate wound/ulcer healing.

For most patients with venous leg ulcers, initial therapy often consists of compression bandages and leg elevation to help control the leg swelling.

For patients with leg swelling secondary to venous insufficiency who are intolerant of compression bandages, there may be an option of using pneumatic “edema pumps” to help gently massage the excess fluid from the leg(s).

In circumstances where structural vein problems are confirmed the underlying abnormality can often be fixed using minimally invasive (outpatient) procedures.

PERIPHERAL ARTERIAL DISEASE [PAD]

Accumulation of “plaque” within the walls of the arteries affecting the legs is commonly referred to as peripheral arterial disease [PAD].

Similar to the situation that occurs with a narrowed pipe, when plaque accumulates within the walls of the arteries it becomes difficult for oxygenated blood to flow from the heart to the legs.

Peripheral arterial disease [PAD] is a common (and under-diagnosed) condition. In the United States an estimated 10 million people are affected with PAD.

Symptoms
Diagnostic Workup
Treatment

Somewhat surprisingly, many patients with PAD are asymptomatic. In this situation plaque accumulation has developed within the walls of the arteries, however, the degree of reduction of arterial blood flow to the legs has not yet reached a critical level and blood is still able to flow through (or around) the narrowing in the artery.

As the burden of plaque increases, it becomes increasingly more difficult for oxygenated blood to be delivered to the muscles and tissues of the legs.

In general PAD is a slowly progressive condition, however, occasionally the condition will present suddenly (acutely).

With low-grade levels of PAD patients typically experience pain or cramping in their legs when walking. Although the pain can occur anywhere in the leg calf cramping is particularly common.  The medical name for this symptom complex is “claudication.”

With more severe levels of PAD patients can experience pain in their legs with minimal activity or even when at rest (“rest pain”).

In severe cases of PAD patients can develop ulcers (wounds), discoloration of the skin of the feet and toes, and are at risk for developing gangrene of the toes/foot.

Initial diagnostic testing for PAD often involves a simple test known as the “ABI” test.  “ABI” is an acronym that stands for “Ankle-Brachial Index”. In this test blood, pressure cuffs are used to compare the pressure of arterial blood flow in your legs compared to your arms.

Another commonly utilized form of diagnostic study used in the evaluation of PAD is a specialized form of ultrasound testing known as duplex ultrasound.

In some situations, additional diagnostic tests such as CT-scans and MRI scans may be required.

Nearly all patients with confirmed PAD will benefit from medications that are intended to reduce further plaque accumulation, reduce the risk of “plaque rupture”, or decrease the risk of blood clot formation.

In many patients, blood flow to the legs can be improved using “minimally-invasive procedures”.

One of the most common procedures performed to improve the blood flow to the legs is called “angiography” or “angiogram”.  In this procedure, a thin piece of flexible tubing is used to inject dye directly into the artery. As the dye is injected x-ray images allow real-time evaluation of blood flow through the area of concern, and can accurately delineate the location and the degree of narrowing in the artery.

In many situations, it is possible to treat the narrowing or blockage at the same time the angiogram is performed. The catch-all phrase used to describe vascular procedures done with the guidance of angiography is “endovascular therapy”.

A wide variety of treatment options can be performed at time of angiography:

  • Balloon angioplasty (dilating the narrowing with a balloon)
  • Stent deployment (insertion of cylindrical metallic lattice that acts as a structural scaffold; allows blood to flow through a previously narrowed area.
  • Atherectomy procedures (procedures designed to directly remove plaque from the wall of the artery). Common atherectomy options include devices that rotate or spin rapidly within the artery, and laser devices.

In some situations, surgical bypass around the arterial blockage may be the best option. In this situation, a length of vein (or artificial tubing) is surgically attached to an area above the blockage, tunneled around the blockage, then re-connected to the artery below the blockage.  Blood is then able to flow through the new flow channel to the leg.

Increasingly the aforementioned techniques are used in combination.  It is not uncommon for patients with PAD to undergo a variety of procedures, which may including both endovascular and surgical modalities of care.

Vascular surgeons specialize in the endovascular and surgical care of peripheral arterial disease.

Symptoms

Somewhat surprisingly, many patients with PAD are asymptomatic. In this situation plaque accumulation has developed within the walls of the arteries, however, the degree of reduction of arterial blood flow to the legs has not yet reached a critical level and blood is still able to flow through (or around) the narrowing in the artery.

As the burden of plaque increases, it becomes increasingly more difficult for oxygenated blood to be delivered to the muscles and tissues of the legs.

In general PAD is a slowly progressive condition, however, occasionally the condition will present suddenly (acutely).

With low-grade levels of PAD patients typically experience pain or cramping in their legs when walking. Although the pain can occur anywhere in the leg calf cramping is particularly common.  The medical name for this symptom complex is “claudication.”

With more severe levels of PAD patients can experience pain in their legs with minimal activity or even when at rest (“rest pain”).

In severe cases of PAD patients can develop ulcers (wounds), discoloration of the skin of the feet and toes, and are at risk for developing gangrene of the toes/foot.

Diagnostic Workup

Initial diagnostic testing for PAD often involves a simple test known as the “ABI” test.  “ABI” is an acronym that stands for “Ankle-Brachial Index”. In this test blood, pressure cuffs are used to compare the pressure of arterial blood flow in your legs compared to your arms.

Another commonly utilized form of diagnostic study used in the evaluation of PAD is a specialized form of ultrasound testing known as duplex ultrasound.

In some situations, additional diagnostic tests such as CT-scans and MRI scans may be required.

Treatment

Nearly all patients with confirmed PAD will benefit from medications that are intended to reduce further plaque accumulation, reduce the risk of “plaque rupture”, or decrease the risk of blood clot formation.

In many patients, blood flow to the legs can be improved using “minimally-invasive procedures”.

One of the most common procedures performed to improve the blood flow to the legs is called “angiography” or “angiogram”.  In this procedure, a thin piece of flexible tubing is used to inject dye directly into the artery. As the dye is injected x-ray images allow real-time evaluation of blood flow through the area of concern, and can accurately delineate the location and the degree of narrowing in the artery.

In many situations, it is possible to treat the narrowing or blockage at the same time the angiogram is performed. The catch-all phrase used to describe vascular procedures done with the guidance of angiography is “endovascular therapy”.

A wide variety of treatment options can be performed at time of angiography:

  • Balloon angioplasty (dilating the narrowing with a balloon)
  • Stent deployment (insertion of cylindrical metallic lattice that acts as a structural scaffold; allows blood to flow through a previously narrowed area.
  • Atherectomy procedures (procedures designed to directly remove plaque from the wall of the artery). Common atherectomy options include devices that rotate or spin rapidly within the artery, and laser devices.

In some situations, surgical bypass around the arterial blockage may be the best option. In this situation, a length of vein (or artificial tubing) is surgically attached to an area above the blockage, tunneled around the blockage, then re-connected to the artery below the blockage.  Blood is then able to flow through the new flow channel to the leg.

Increasingly the aforementioned techniques are used in combination.  It is not uncommon for patients with PAD to undergo a variety of procedures, which may including both endovascular and surgical modalities of care.

Vascular surgeons specialize in the endovascular and surgical care of peripheral arterial disease.

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