Saving Limbs With Clogged Arteries

Peripheral arterial disease endangers limbs but revascularization helps

(RxWiki News) With peripheral arterial disease, plaque builds up in arteries, often in the legs. While patients are in danger of losing a limb, restoring blood flow can reduce the need for amputations.

Peripheral arterial disease (PAD) is atherosclerosis of the extremities. As with coronary artery disease, PAD can be prevented by eating healthy, maintaining a normal weight, exercise and not smoking.

If patients get the condition and don’t treat it soon enough, they may have to undergo amputation. But procedures for revascularization (restoration of the blood supply) can save limbs, according to recent research.

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Peter Gloviczki, MD, a vascular surgeon at the Mayo Clinic in Rochester, Minnesota,  and president of the Society for Vascular Surgery, collaborated on research evaluating the effectiveness of revascularization procedures and bypass surgery to reduce the amputation rate among patients with PAD

About 1 in 20 Americans over the age of 50 has PAD, a condition that raised the risk of heart attack and stroke, according to the US Department of Health and Human Services.

As the disease progresses and blood vessels narrow, arterial flow into the lower extremities worsens.

Claudication or a pain, tired or weak feeling that occurs in the legs (usually during an activity such as walking) is often a sign of the disease, but PAD doesn’t always cause symptoms.

In this study, a total of 773 patients, average age 68 years old, underwent 1,906 limb revascularization procedures.

These procedures were endovascular, open surgical or a combination. Endovascular methods are minimally invasive, carried out through a needle-like puncture of the skin and opening blood vessels using stents, balloons or other catheter-based interventions.

Surgical procedures may involve rerouting blood flow around the blood vessel blockage by creating a new pathway for blood flow using a blood vessel graft.

In this study spanning 20 years, these revascularization procedures reduced the need for amputations by 40 percent.

"This is an important study because frequently patients who have peripheral arterial disease—and there are about 12 million Americans who have some leg pain that can be connected to it—may progress to amputation,” said Dr. Gloviczki. “They may develop rest pain, gangrene and, if an intervention is not performed, they may lose the limb. This study shows that the use of endovascular interventions or open surgical bypass effectively reduced the amputation rate."

Patients with leg pain are advised to report it to their physicians, and people with risk factors for peripheral arterial disease, such as smoking, high cholesterol, male gender, hypertension or diabetes, should take care of the medical conditions that may lead to or complicate peripheral arterial disease, Dr. Gloviczki said.

"In addition, patients who have leg pain and peripheral arterial disease frequently have silent heart disease, so the patient and primary care doctor should evaluate, and if the condition is significant, if the pain is something that interferes with the quality of life, then they should consult with a vascular surgeon," he said.

The study was presented at the Society for Vascular Surgery annual meeting in San Francisco from May 30 to June 1 and is not yet published.

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Review Date: 
June 8, 2013