Circulatory problems of the leg
Just as there can be a blockage in your heart arteries there can be blockages in your leg arteries. This can manifest in many ways.
The earliest symptom is an inability to walk long distances. On walking beyond a certain distance a cramping pain is experienced in the muscles, especially in the calf and occasionally in the thigh or buttocks. This is called claudication. This is relieved on resting. Over time, the distance one can walk could reduce. If this happens it should be discussed it with your GP and if appropriate you will be referred you to us. If claudication is the only symptom, the risk of losing the leg is extremely low.
The more worrying symptom is if you get pain in your feet and toes, when you are at rest. You will first notice this when you go to bed. The pain will either keep you up or it will wake you after a couple of hours. The pain may get better if you get up and walk around or simply by hanging your leg by the side of the bed. If the pain worsens and becomes present all the time, you must contact your GP as soon as possible. This suggests that the blood supply is down to critical levels (Critical limb Ischeamia). It is however important to realise that there are other causes of similar pain.
If untreated in these circumstances it can progress to non-healing ulcers or even gangrene with a significant risk of amputation.
What causes the blockages?
The blockages are caused by furring on the inside of the arteries. This happens to everyone and starts around the 30’s. The fur is a combination of fat, blood cells, muscle cells and proteins. As it progresses it could cause a severe narrowing or complete blockage of the artery, which is when it causes symptoms.
Is there anything I can do?
It is important to realise that it is the same disease which causes heart attacks and stroke. You could help yourself in a number of ways. STOP SMOKING. Eating a balanced diet and doing moderate exercise will make you healthier. You need to make sure your blood pressure is well controlled. If you are a diabetic you need to make sure your sugars are well-controlled using diet and drugs.
A small dose of aspirin (75mgs) may be recommended by your doctor as it thins your blood and improves your circulation. You need to have your cholesterol checked and reduced if it is high. This can be done with diet and statins.
Do not start any drugs without first consulting your doctor.
Does everybody need treatment?
Not everybody needs surgical treatment. If your symptoms are claudication the majority will be treated with lifestyle modification and drugs.
In patients with claudication intervention is only considered if your symptoms are severe or if they affect your work. You will have a scan of your arteries and the treatment will be discussed with you based on the scan. Your general health will have an impact on choosing the right treatment.
If however you have critical ischaemia then you will need treatment to improve you circulation.
What are the complications?
The risk of complications with angioplasty and stenting are minimal. However, they do exist and can occasionally make your blockages worse. You could form a big bruise in your groin. The artery, which is angioplastied can block up straight away often requiring surgery. Very rarely does the artery rupture causing bleeding. This would require immediate surgery. In the long term the same area can block up again.
Open surgery does carry the risk of major complications. Any surgery puts a degree of strain on your heart and other vital organs such as the kidneys and the lungs. The more common complications are wound infection and bruising around the wounds, both of which can occasionally lead to further surgery.
The artery or the graft can block up straight away which will again mean further surgery. In some cases the graft may not work at all.
In the long term about 15-20% of grafts will block up in about 3-5 years time.