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Lower Extremity Disease

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Segmental blood pressure readings measure blood pressure at several points on the leg.
Segmental blood pressure readings measure blood pressure at several points on the leg.

To provide more information about the location and extent of lower extremity disease, physicians may run additional tests, including:

  • Pulse volume recording and segmental blood pressure tests: Pulse volume recording is a modified form of blood pressure testing that measures the volume of blood flow through various points on the legs. The test uses an arm pressure cuff and a Doppler transducer and provides information about arteries that have atherosclerotic plaques. If the physician is confident that symptoms are due to PAD, yet the ABI and pulse volume recordings are normal, the patient may repeat the test after walking on a treadmill.  This treadmill is at a slow speed, but at an incline, which often reproduces the discomfort.
  • Duplex ultrasound: Duplex ultrasound, an accurate and completely painless, noninvasive test, combines traditional ultrasound with Doppler technology. Ultrasound reflects high-frequency sound waves off tissues in the body; a computer captures the echoes and creates a picture of those tissues. In addition, duplex ultrasound allows physicians to measure real-time blood flow and its abnormalities. As blood cells move, the sound waves reflecting off of them change pitch, much like a car horn changing pitch as a moving car passes. This change in pitch enables physicians to measure the speed of blood flow and to identify changes in blood flow dynamics, such as the presence of collateral circulation or blockages and narrowing in an artery.
  • Magnetic resonance angiography (MRA): MRA, a type of magnetic resonance imaging (MRI), uses magnetic fields to create highly detailed cross-sectional images of blood vessels. Physicians use MRA to view arteries and the blockages inside arteries that affect blood flow. This process is painless, and the images are as good as invasive angiography (see below). Unlike standard angiography, this test does not require the injection of dye.
  • Computerized tomography angiography (CTA): CTA, a specialized type of x ray test, uses dye injected in a small intravenous catheter placed in the arm to image the arteries of the legs. With newer scanners, the images rival those obtained by invasive angiography. Patients who have kidney function problems may not be candidates for this test.
  • Angiography: Angiography produces x rays of the arteries in the leg. To perform angiography, the physician threads thin tubes called catheters through the arteries and takes x ray pictures, called arteriograms, by injecting contrast dye through the catheter and into the arteries. Because the dye is radiopaque, which means that x rays cannot penetrate it, the test can show the location and severity of atherosclerotic arterial disease as the dye flows through the bloodstream. The test is highly accurate, but several drawbacks prevent its routine use. Injection of the dye can cause discomfort, and some people have allergic reactions to the contrast dye. The dye also interferes with normal kidney function, presenting a risk for kidney failure to people with kidney ailments and requiring that all patients who undergo the test stay well hydrated. Angiography is used only in people with severe lower extremity disease who require invasive treatment to re-establish adequate blood flow.

TREATMENT APPROACH

Lower extremity disease is a serious condition. Left untreated, the disease will continue to progress and could cause gangrene, which could require amputation of the leg or the foot. Even though many treatments are available for lower extremity disease, the condition cannot be cured. Treatments prescribed by the physician must be continued long-term.

Fortunately, Quitting smoking halves the chances of developing the disease and can reverse the course of the disease. Patients who continue to smoke will make the condition progressively worse. Smoking can cause symptoms to advance from pain in the limbs to severe limb ischemia, which increases the risk of amputation. Continuing to smoke may also cause other health problems, such as a heart attack, stroke, and cancer, and increase the risk of dying.

Exercising: Exercise opens arteries and relieves -- and in some cases reverses -- intermittent claudication. Physicians recommend people with PAD walk for at least 30 minutes 3 times each week, which may require people to continue walking through leg pain right up to the point where the pain begins to become more intense. Walking programs, best performed under the supervision of an exercise trainer, can double or quadruple pain-free walking distance.

Eating right: The physician may recommend a diet lower in fat, cholesterol, and calories to help lower blood cholesterol levels and prevent the progression of atherosclerosis.

If a patient has an underlying condition, such as hypertension or diabetes, treating that disease may improve symptoms of lower extremity disease. Patients with diabetes should closely monitor blood glucose levels to slow progression of the disease. Patients with hypertension or high cholesterol should continue any antihypertensive or lipid-lowering medications that the physician has prescribed and approved.


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