Overview
What Is Peripheral Vascular Disease ?
Your arteries are normally smooth and unobstructed on the inside but they can become blocked through a process called atherosclerosis, which means hardening of the arteries. As you age, a sticky substance called plaque can build up in the walls of your arteries. Cholesterol, calcium, and fibrous tissue make up the plaque. As more plaque builds up, your arteries can narrow and stiffen. Eventually, as the process progresses, your blood vessels can no longer supply the oxygen demands of your organs or muscles and symptoms may develop.
What Can I Expect ?
Prior to your procedure, tests may be scheduled such as blood work, electrocardiogram (ECG), and chest x-ray. These may be done at a separate appointment, or the day of the procedure
Your physician will order tests to locate the blockage and choose the best places to connect the graft.
These Tests Include:
- Duplex Ultrasound: a non-invasive test that uses high-frequency sound waves to measure real-time blood flow and detect blockages or other abnormalities in the structure of your arteries
- CT Angiography: which produces x-ray pictures produced by an ultra-fast CT scanner, of the blood vessels in your legs using a contrast dye that is injected to highlight your arteries
- Magnetic Resonance Angiography (MRA): which uses magnetic fields and radio waves to show blockages inside your arteries
- Angiography: which produces x-ray pictures of the blood vessels in your legs using a contrast dye that is injected to highlight your arteries
If you have arm or leg artery disease, your physician may order segmental blood pressures or pulse volume recording to determine the narrowing of the arteries in your arm or leg.
If you have had a heart attack in the past, or if you have chest pain, your physician might recommend a stress test or, possibly, a heart catheterization.
Your physician or vascular surgeon will give you the necessary instructions you need to follow before the surgery, such as fasting. Usually, your physician will ask you not to eat or drink anything 8 hours before your procedure.
Your physician will discuss with you whether to reduce or stop any medications that might increase your risk of bleeding or other complications.
What Happens During Surgical Bypass ?
Your specific surgical procedure depends on your symptoms, your overall physical condition, and how much plaque has built up in your arteries. Your surgeon, with the help of your anesthesiologist, may use either general or regional (epidural or spinal) anesthesia for the procedure.
For an arm or leg bypass, your vascular surgeon usually first selects and removes the vein that will serve as the bypass graft for your artery. Your vascular surgeon usually uses your great saphenous vein (GSV) for the graft, if it is suitable. Your GSV runs under your skin between your foot and your groin. Sometimes your surgeon may need to use another vein or a synthetic fabric artery for the graft.
What Are The Risks Of Surgical Procedures ?
All surgeries pose a certain amount of risk. In general, the risks of surgery for peripheral arterial disease (PAD) of the legs are similar to those of other types of surgery.
These Risks include:
- Infection from the incision.
- Bleeding.
- Heart attack or stroke.
- Leg swelling.
- Failed or blocked grafts.
How Is Peripheral Arterial Disease Treated ?
Lifestyle changes and medicine often can stop or even reverse the buildup of plaque in your arteries and improve the quality and length of your life. In many people, leg pain decreases after they have used these treatments for several months.
Quitting smoking is by far the most important factor in treating peripheral arterial disease. And studies show that nicotine replacement therapy; use of the medicine bupropion, nortriptyline, or varenicline (Chantix); and supportive therapy significantly increase long-term success in quitting. This success can be critical, because continued smoking is associated not only with PAD symptoms getting worse but also with a poor outcome, including a higher chance of having an amputation. If you use a nicotine replacement product or take the medicine bupropion or nortriptyline, you can double your chances of quitting tobacco for at least 6 months.
Your doctor also will strongly advise that you follow a heart-healthy diet and an exercise program. You will probably need to take cholesterol-lowering medicines. People with diabetes should try to keep their blood sugar levels as close to normal as possible.
People with PAD who have intermittent claudication have a higher risk for death, mainly from stroke and heart attack, compared to other people the same age. Aspirin and strict blood pressure control is often recommended to reduce this risk.
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