What is vascular disease?
Diseases of blood vessels in places other than the heart or brain are called peripheral vascular disease. Most often, the cause is narrowing of the vessels due to a build-up of fatty plaque (atherosclerosis). The main locations are the legs, stomach, kidneys, and neck (carotid) arteries leading to the brain. When plaque clogs a vessel, blood supply is reduced and clotting risk increases. Risk factors for peripheral artery disease are the same as for coronary artery disease.
What are the symptoms?
Vascular disease in the legs often causes leg pain or cramping during a walk (intermittent claudication). Other leg symptoms of poor blood flow are numbness, coldness, or slow-healing sores. In severe cases, pain happens at rest and there are risks of infection, gangrene (tissue death), and need for amputation. Vascular disease in the neck (carotid artery disease) usually does not cause symptoms but there is increased risk of stroke or transient ischemic attack (TIA, or mini-stroke), which can produce sudden numbness or weakness in the face, arm, or legs; slurred speech; or sudden blindness in one eye. Vascular disease in the upper extremities, the kidneys, or in the gut produce other symptoms. Any peripheral artery disease is also a warning of heart disease risk.
How is it diagnosed?
A physical exam, blood tests, history, and tests such as:
- Ankle-brachial index: precise blood pressure measurements on feet and arms
- Ultrasound: a non-invasive test using sound waves to create a picture of blood flow through arteries (sometimes called Doppler or ultrasound duplex imaging)
- CT angiography: a non-invasive test using 3D X-rays and an injected dye (contrast material) to create a picture of blood flow through arteries in the legs, neck, abdomen, or pelvis
- Other possible tests may include: Magnetic resonance angiography; contrast angiography or cerebral (brain) angiogram (both require catheter-delivered dye for contrast)
How is vascular disease treated?
Same as for coronary artery disease; foot self-care; exercise
Often the same as prescribed for coronary artery disease; for carotid artery disease, anti-clotting medication is important to prevent stroke; for leg symptoms, anti-claudication drugs (e.g., cilostazol); to break up existing clots, thrombolytic therapy
Procedures & Surgery
Using precise imaging technology and minimally invasive endovascular techniques (procedures done with tools at the end of long thin flexible wires inside the vessels), Temple interventional cardiologists can restore blood flow to relieve pain, improve quality of life, and/or avoid serious health risks. Examples:
- A balloon on the tip of a catheter (balloon angioplasty) can force open the blockage and a mesh tube (stent) can keep it open
- In the legs, abdomen, or pelvis, vascular surgeons can use natural or synthetic vessels to bypass narrowed arteries
- For severe carotid artery disease, surgical removal of plaque (carotid endarterectomy) is common but in some cases angioplasty and stenting is required instead
- New minimally invasive methods to open vessels now available at Temple include atherectomy (blades, orbital, laser), drug-eluting stents, and clot-catching filters