The Doctor Is In

More than just a pain in the leg

by Luke Erdoes, MD

More about PAD

If you have PAD, you:

must stop smoking. Even one or two cigarettes daily can harm your health.
need to lower your blood pressure, cholesterol, and blood sugar to targets recommended by your doctor.

The risk factors for PAD include:

smoking
diabetes
elevated fats in the blood such as cholesterol
high blood pressure
heart disease
a family history of heart or blood vessel problems or stroke.

A stroll around the block or a tour through a shopping mall may be easy for some people. For others it's a pain in the leg.

Although many people feel that leg pain while walking is simply part of getting old, discomfort when you walk for even a short distance could be due to blockages in the arteries leading to or within the legs. These blockages are also called peripheral arterial disease or PAD.

Behind the pain The underlying cause of PAD are fatty deposits that clog the leg arteries, limiting or blocking blood flow. Left untreated, PAD can cause continuous pain in the foot, problems with healing of lower limb sores, and an increase in the risk of infections and tissue death (gangrene) that can lead to limb amputation or even death.

The leg blockages can also indicate blockages elsewhere. If you have PAD, you probably have blocked arteries in other areas of your body as well – which can lead to heart attack or stroke.

Vascular surgery PAD is often treated with vascular surgery, which is the treatment of diseased blood vessels anywhere in the body except the heart. Traditionally almost all vascular procedures required long, open incisions. Today, however, up to 80 percent of these procedures require only needle punctures, balloons to stretch open blockages, or stents to prop open the blockages.

Removing strips of plaque Another promising technique for PAD is called atherectomy (ath-er-EK-to-me). This procedure utilizes a tiny cutter to remove strips of plaque from the artery. The plaque is deposited into the nosecone of the device and removed from the body. After cleaning, the device can be reinserted into the artery to remove more plaque.

Atherectomy has the advantages of not stretching the artery or splitting the layers. This causes less scarring and less reblockage of the treated area, which is particularly important for individuals with diabetes who have a high rate of reblockage with balloons or stents. By not disrupting the layers of the artery, less scar tissue forms. Formation of scar tissue is the main reason that arteries renarrow after a procedure. Also, by not leaving a stent behind, reblockage can be minimized and breakage of the stents (called stent fractures) can be avoided. Stent fractures often lead to increased chances of reblockage, as well as making repeat treatments more difficult.

Reblockage, although rare, can still occur after atherectomy. If necessary, the procedure usually can be repeated with similar techniques only requiring needle punctures. The procedure also does do not preclude the use of more traditional open techniques at a later date.

Promising results So far, the results of atherectomy are very promising. People with pain in their feet, non-healing sores, or even gangrene, have been able to heal and walk again without pain. Atherectomy is also being used to correct previously unsuccessful procedures in the leg, and other applications of atherectomy are being researched.

Patients who have endovascular procedures are experiencing earlier hospital discharges, decreased pain, and good results. Up to 80 percent of endovascular procedures continue to function well a year later. We are treating more people with less invasive procedures – with very gratifying results.

Luke Erdoes, MD, vascular surgeon, practices with University Surgical Associates. He is also an Assistant Professor of Surgery with the UT College of Medicine Chattanooga. For more information, call Erlanger’s physician referral line at 423-778-LINK(5465).