Peripheral arterial disease (PAD) is common circulation problem in which the arteries that carry blood to the legs or arms become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain, but often causing no symptoms that all. PAD clogged or narrowed arteries in the legs are a red flag because PAD is associated with other life-threatening vascular diseases.
Twelve to 20 percent of Americans older than 65 suffer from peripheral arterial disease but only one-third are symptomatic. Identifying pad while asymptomatic can be life-saving. Early detection by an interventional radiologist can save people from future stroke, heart attack, or an early death.
PAD Risk Factors
|Risk factors beyond your control||Aspect you can manage|
Peripheral arterial disease can be improved with lifestyle changes. Smoking cessation, diet, and exercise can improve symptoms and slow progression disease. Moving increases the distance that people with PAD can walk pain-free. Diabetes, high cholesterol, and high blood pressure can all be managed with diet and medication.
The most common symptoms arterial disease is claudication, a cramping pain in the hips, thighs, or calves that occurs when walking or exercising and disappears when the person stops the activity.
Other symptoms of PAD include:
- Numbness and tingling in the lower legs and feet
- Ulcers or sores on the legs or feet that don’t heal
- Noticeable temperature differences in your lower leg or foot, compared to the other leg of the rest of your body
Diagnosis and Treatment
There are several methods to diagnose peripheral arterial disease. The first step, your physician examines your legs and checks for a weak pulse. Next, they may use one of the following techniques:
- Ankle brachial index (ABI) – This test is a comparative blood pressure reading of the arm and ankle to determine how well your blood is flowing. It is an accurate measure of fatty plaque buildup in leg arteries and a secondary assessment of plaque accumulations in the entire cardiovascular system.
- Doppler and Ultrasound (duplex) Imaging – This is a non-invasive measure of blood flow in the artery using sound waves
- Computed Tomography Angiography (CT) – Another non-invasive test that is used to view the arteries in the abdomen, pelvis, and legs using x-ray technology. This test is especially useful for patients with a stent or pacemaker.
- Magnetic Resonance Angiography (MRA) – A test similar to CT, MRA uses magnets instead of x-rays to produce a series of images.
- Angiography – An angiogram is used to visualize blood flow, view arteries in the legs and identify blockages by injecting a contrast dye into the arteries and taking x-rays.
If a blockage is found, one or both of the following non-surgical, minimally invasive procedures can be used:
The procedure consists of the following:
- An incision is made in the leg or the neck
- A tube called the sheath is inserted in the artery
- A specially-designed catheter with a tiny balloon at the tip is guided to the blockage in the artery and inflated to increase the blood flow.
Stents are small cylinders made of a wire mesh that is implanted in an artery to help support and hold it open. Some stents include medicine, which is used to decrease the possibility of re-blockage.
This procedure is a minimally-invasive clot removal treatment:
- The stent is inserted using a balloon catheter.
- Once the stent is placed, the balloon is removed and the stent remains.
Angioplasty and stent placement usually requires a 24-hour hospital stay. Medications may be prescribed by your physician, and it may take six to eight weeks for full recovery.
Leg vein treatment is not only for women. Both men and women get varicose veins and spider veins, but they tend to be more common in women.
Varicose veins occur because the walls in the veins become weakened and enlarged. They usually appear in the legs or around the pelvis, but can also occur in different locations in the body. Since the affected veins are close to the surface of the skin, in addition to being visible, they may appear lumpy and contorted. Factors that add to the development of varicose veins include: age, family history, long periods of sitting or standing, pregnancy, and weight.
Veins return the blood to the heart so it can be recirculated. In the legs, there are three types of veins that are affected by varicosity:
- Superficial veins – located closest to the skin. They include the greater and lesser saphenous veins.
- Perforating veins – the junction between superficial and deep veins.
- Deep veins – located in the muscles and connect to the vein that runs directly to the heart. They include the femoral popliteal, tibial, and iliac.
While many varicose veins are painless and unpleasant from a cosmetics stance, some ache and cause great discomfort. Treatments range from self-care to medical procedures that close or remove veins.
Symptoms generally occur in the legs around the ankles. They are usually worse after standing or sitting and may include: burning, itching, throbbing or tingling, skin discoloration, swelling, and ulcers
When to see a Doctor
Ask your doctor’s advice if your varicose veins are painful when you walk or stand. Contact your doctor if:
- An ulcer or painful lump develops on or near a varicose vein
- Your legs, feet, or ankles suddenly become swollen
- The skin over your varicose veins bleeds
WVU Medicine interventional radiologists offer several minimally invasive outpatient options for treating varicose veins. The procedure used depends on your physical health and the size and location of the affected veins.
Treatment options include:
- Sclerotherapy and foam sclerotherapy
- Two types of thermal ablation procedures
- Ambulatory Phlebectomy
There is no guaranteed way to prevent varicose veins, but exercise, elevating your legs, or wearing compression stockings can ease the pain and may stop them from getting worse.
Do’s and don’ts of varicose veins
- Do wear compression stockings
- Do exercise regularly
- Do lose weight
- Do elevate your legs twice a day for 30 minutes
- Don’t wear tight fitting clothes
- Don’t cross your legs while sitting down
- Don’t sit or stand in one position for long periods of time
In most cases, small varicose and spider veins tend to be unattractive cosmetic issues that can be easily treated with sclerotherapy. The procedure is minimally invasive and effective. A solution is injected into the veins, causing the walls of the blood vessels to collapse and seal, and blood flow is rerouted to healthier veins.
Diagnosis and Treatment
First, patients undergo a physical exam, provide their medical history, and have a Leg evaluation. Next, an ultrasound may be ordered to rule out underlying issues. If the ultrasound is performed, the interventional radiologist will evaluate the results. The last step is discussing treatment options.
Sclerotherapy is performed on an outpatient basis, taking about 30 to 40 minutes to complete. It often requires multiple treatments depending on the type, number, and size of veins treated.
There are two types of sclerotherapy, and both procedures use the same sclerosing agent. The difference is:
- Sclerotherapy – is good for treating spider or small varicose veins.
- Foam sclerotherapy – is effective for treating veins that are longer and larger, in the sclerosing solution is mixed with air until it is a similar to the consistency of shaving cream.
It is important for patients to understand, this procedure does not provide instant, but gradual results. Depending on the number of treatments required, it may take between two to three months for veins to show improvement. They need time to recover after the treatment.
Patients need to wear a compression hose following the procedure, but can resume normal daily activities immediately.
Endovenous thermal ablation therapy (EVLT) and radiofrequency ablation (RFA) are image-guided, minimally invasive procedures that are used to treat venous reflux disease. The procedures are used to ease symptoms from dysfunctional, inflamed, discolored, or ulcerated veins, but also can be used for cosmetic purposes.
Both procedures heat the inside of the vein to seal it off, and the body automatically direct the blood to healthier veins. The difference in the procedures is the energy source; EVLT uses laser energy and RFA uses radiofrequency energy.
The EVLT and RFA procedures are performed on an outpatient basis using local anesthetic and pain medication. The procedures take between one and two hours to complete with minimal discomfort.
Your interventional radiologist will determine which procedure is best for your condition.
It is important to know:
- These procedures do not provide instant, but gradual results and may take between two to three months for veins to fully improve.
- These treatments are not for spider veins, but sclerotherapy can be used in conjunction with EVLT.
- After the procedure, patients may still have varicose veins; however, they will be less noticeable.
Diagnosis and treatment
First patient undergo a physical exam, provide their medical history, and have a leg evaluation. Next, an ultrasound may be ordered to rule out underlying issues and will determine if you are a candidate for the procedure. The last step is discussing the treatment with the interventional radiologist.
For endovenous laser treatment the procedure will take between one to two hours to complete. Patients lie on a special treatment table and wear protective eyewear to shield their eyes from the laser. After a local anesthetic, the catheter and laser are inserted into the vein. When it reaches the optimal location, the laser is activated, and heat applied to the vein wall, causing the vein to close.
For radiofrequency ablation, the procedure takes about two hours to complete. After a local anesthetic, the catheter is guided to the precise location using ultrasound, and the radio frequency generated heat is delivered to the vein wall, causing the vein to shrink and seal.
Following procedure, patients need to wear compression hose.
Patients can usually return to work within 24 to 48 hours. Normal daily activities can be resumed in about a week to ten days.
After the procedure, a follow-up appointment will be scheduled.
NOTE: These treatments may be covered by insurance if they are deemed medically necessary procedures by your insurance company.
Ambulatory phlebectomy, also known as microphlebectomy, is a minimally-invasive procedure used to treat large bulging varicose veins near the skin surface. This treatment is used for veins that are either too small to treat with endovenous ablation therapy or too big for sclerotherapy.
The interventional radiologist makes small incisions in the leg, and collapses and removes the enlarged varicose veins via the incisions. Ambulatory phlebectomy can be combined with endovenous laser therapy (EVLT) for more extensive varicose vein treatment.
Diagnosis and Treatment
Patients undergo a physical exam, provide their medical history, and have a leg evaluation. An ultrasound is used to evaluate the blood flow through the legs. The results of the ultrasound help determine if the procedure will be beneficial for your condition.
Be sure to tell your doctor if you:
- Are a diabetic
- Have a coagulation disorder
- Are taking medications
- Are taking herbal supplements
- Are allergic to local anesthetics like Lidocaine Procaine or Benzocaine
- Are pregnant
Ambulatory phlebectomy is performed on an outpatient basis and takes approximately two hours. Once the leg is prepped, the areas numbed with a local anesthetic. The veins are collapsed and the bulging veins are removed. When the procedure is complete, the incisions are covered with a compression wrap.
After the procedure, patients need to wear compression hose for about two weeks. The incision scars should fade within a few months
Most patients are able to stand and walk following the procedure. Patients may return to work next day and resume regular activities provided the compression stockings are worn. However, strenuous activity should be avoided for about two weeks following the procedure.
A follow-up visit will be scheduled in seven to ten days after your procedure.