Peripheral Arterial Disease

Peripheral arterial disease (or peripheral vascular disease/hardening of the arteries) is caused by a blockage or narrowing of the arteries and can affect all regions of the human body. These blockages are most commonly caused by a process called atherosclerosis (hardening of the arteries), which causes a build up of plaque (cholesterol rich) on the inside lining of the artery.

Peripheral arterial disease is usually a disease that affects us as we get older. In very rare circumstances, it can affect younger patients too. The most common risk factors and associations for peripheral vascular disease include:

• High blood pressure (hypertension)
• Diabetes
• Heart disease (ischaemic heart disease, heart attack, angina)
• High cholesterol levels (hypercholesterolaemia)
• Smoking
• Family history
• Poor diet/lifestyle

Arteries perform the critical function of supplying blood that carries oxygen to the various muscles and organs in the body. When there is a blockage or narrowing, the amount of oxygen that reaches these vital tissues is decreased and damage can occur and symptoms of arterial insufficiency can become apparent.

Limbs – blocked arteries affecting the lower limbs can cause pain in the calves, thighs or buttocks when walking which is called ‘claudication’. This can manifest after walking various distances or durations, but is usually different with each patient.

Essentially, there is insufficient blood that is reaching the muscles in the legs. This causes the body to undergo certain processes that creates a build up of acid in the muscles that causes the characteristic ‘burning pain’ in the back of the calves. Usually, the pain goes away after resting and characteristically comes back after walking a similar distance or duration.

With more severe narrowing or blockages, the distance or duration of walking becomes less before the symptoms of claudication occur (short distance claudication), and there may be pain in the feet particularly at rest without performing any walking at all (rest pain). Rest pain typically occurs when lying down to sleep and can sometimes be relieved by hanging legs down over the edge of the bed. There may be insufficient blood and oxygen for healing of tissues, and skin ulcers and breaks of the skin can develop leading to gangrene.

The upper limbs are far less commonly affected by peripheral arterial disease when compared to the lower limbs. Similar symptoms can occur in the arms and hands including pain when using the arms/hands and also ulcers and skin breaks in the fingers most commonly.

Neck – blocked arteries in the neck (usually the carotid artery) can cause a stroke or mini stroke when a particle of a cholesterol plaque breaks off, travelling upward and blocking a small artery in the brain.

Unfortunately in most cases, the narrowing or blockage in the carotid artery does not cause any symptoms (asymptomatic) until the stroke or mini stroke occurs.

Symptoms can include weakness down one side of the body (hemiparesis), slurred speech, visual disturbance with sudden loss of vision in one eye, facial droop on one side and confusion.

Symptoms can be temporary and completely resolve within 24 hours (transient ischaemic attack or TIA), or can persist beyond 24 hours and become permanent (stroke). If you develop these symptoms it is advisable that you seek medical attention as soon as possible as treatment of TIA and stroke can be time critical.

In certain circumstances it is advisable to treat a blocked carotid artery to reduce your risk of having a TIA or stroke even though you may not have had symptoms. Please see section on stroke/TIA for more information.

Gut – blocked arteries to the gut (small and large bowel) is an uncommon cause of pain after eating a meal and can also cause significant unintentional weight loss. The symptoms can be difficult to attribute to blocked arteries as other conditions frequently cause similar symptoms and a high index of suspicion is required.

Kidneys – blocked arteries to the kidneys can cause high blood pressure (hypertension) that is resistant to medications and can also cause a decline in renal function. The kidneys control the body’s blood pressure through complex processes by determining the amount of blood that travels to the kidneys. If the amount of blood that travels to the kidneys is reduced through narrowing or blockages, the kidney reacts by increasing the blood pressure. Most commonly a kidney specialist is consulted in making this diagnosis.

At Yarra Vascular Surgeons we treat arterial blockages with various techniques, including the latest minimally invasive endovascular surgery (balloon and stenting) and traditional open surgery techniques (cleaning out artery or bypass). Medical management through risk factor optimisation and modification including treatment of blood pressure and cholesterol levels, diabetes control, and smoking cessation is also an important part of our treatment approach and we regularly involve specialists in these areas to participate in your overall care.

We strive to ensure that any procedure we have performed is durable and remains optimised through regular surveillance both clinically and with ultrasound scanning. Once you are a patient with Yarra Vascular Surgeons we develop a lifelong clinical relationship, ensuring that we do our best to ensure that all aspects of your vascular health remains optimised.