12 Jul Leg Amputation Can Be Avoided in PAD Patients
It is estimated that there are more than 150,000 amputations performed in the US annually which involve the toes, legs, and feet due to advanced peripheral artery disease (PAD). The good news is there are treatment solutions and different medical procedures that can help to restore blood flow and help reduce the risk of amputation.
PAD patients at risk of losing a leg suffer from critical limb ischemia (CLI), which is a serious condition in which there are inadequate blood flow and oxygen to the legs. Ischemia is a severe condition that causes tissue damage and can eventually lead to loss of limbs.
Early symptoms of ischemia may include claudication (pain, burning, or cramping in the muscles with exercise that goes away with rest). This can progress over time to CLI, the reduction of blood flow to the affected extremity that results in severe pain or tissue loss.
The pain is known as “rest pain” because it happens when resting or asleep. The pain can be relieved temporarily by hanging the leg over the bed or walking. If the tissue of the limb has been affected, a non-healing sore or even gangrene may occur. Sudden onset of leg ischemia may cause severe pain, loss of pulses, coldness of the limb, paleness of the skin, and even leg weakness and loss of sensation. Patients should seek immediate medical attention if any of these symptoms occur.
To diagnose your condition, your doctor may order an ankle brachial index test (ABI), which tests the blood pressures in the legs. Depending upon those findings, you may be sent for an ultrasound imaging of the arteries or magnetic resonance arteriography (MRA) or CT scan. In some cases, particularly with critical limb ischemia, your doctor may also order an arteriogram, which is an x-ray of the arteries while dye is injected into the blood vessels.
There are several factors that increase a PAD patient’s risk of ischemia including smoking, advanced age, high cholesterol, high blood pressure, diabetes, a family history of cardiovascular disease, sedentary lifestyle, and obesity.
It is critical in ischemia to control the risk factors that led to the condition, especially smoking cessation, is essential! It may prevent progression of the ischemia and save your limb or your life. Treatment is focused on getting more blood supply to the area of ischemia.
Several medications may be prescribed to prevent further progression of the disease and to reduce the effect of contributing factors such as high blood pressure and cholesterol. Medications that fight infections and pain medications may also be prescribed in certain cases.
If you experience claudication in the legs, a supervised exercise routine may be prescribed. Regular exercise may also result in other benefits such as weight loss, lower blood pressure, lower cholesterol, and better control of diabetes.
In many cases, an endovascular procedure may be performed within the artery using clot-busting drugs to dissolve clots (thrombolysis), a balloon to widen the artery (angioplasty), and/or a wire reinforced stent which remains inside the artery serving as a scaffolding to keep it open. In some cases, a bypass of the affected artery may be performed. Either a segment of leg vein or an artificial tube is attached surgically above and below the blockage to detour blood around the blocked area thereby allowing the blood to reach the area of ischemia beyond the blockage.
It’s much better to undergo a moderately intrusive procedure or operation and save the limb than it is to undergo an amputation. Therefore, it is extremely important for PAD patients to seek immediate medical attention for leg pain, weakness or loss of sensation in their legs. Also, seek medical attention for any unhealed sores or discoloration on the legs.
If you have PAD or if you are concerned that you may have it, contact us at Coastal Vascular Center today. We have a range of treatment options and can work with you on strategies to lower your risk of peripheral artery disease.