Lower Extremity Arteriosclerosis

What is lower extremity arteriosclerosis and why is it important?

At birth, the lining of your arteries is smooth and glistening, however, as we age, deposits of cholesterol, calcium and fibrous tissue called plaque may be deposited inside the artery. This plaque is called arteriosclerosis, artery blockage and hardening of the arteries. An artery is designed to handle a ten-fold increase in blood supply but as it becomes narrowed by the buildup of plaque, its ability to supply blood downstream decreases. Small degrees of narrowing are not worrisome but if major arteries become plugged, problems may occur. Arteriosclerosis is a problem that affects arteries all over the body but it tends to occur in predictable places. It causes most heart attacks, some strokes, and reduces blood supply to lower extremities. Arteriosclerosis in the heart or carotid arteries should be treated before problems develop but arteriosclerosis in the lower extremity arteries supplying the legs need not be treated unless it causes signs or symptoms that limit your enjoyment of life.

How will I know if I have lower extremity arteriosclerosis?

Usually, arteriosclerosis develops slowly and silently, never causing a problem, but if it prevents sufficient blood getting to where it is necessary, such as the calf muscles or feet, symptoms may occur. Sometimes, calf muscles become tight with exercise limiting one’s ability to walk. At other times, with more plaque buildup a lack of blood causes pain or numbness in the feet at night which is relieved by putting one’s feet on the floor. If the amount of blood falls below a critical threshold sores may appear, small injuries may not heal and a toe may die, becoming black (gangrene). This is definitely a sign that treatment is necessary to save a limb.

What tests are useful to evaluate lower extremity arteries for arteriosclerosis?

Traditionally, physicians start by asking you questions about your medical history and how you are affected by arteriosclerosis before examining you and your arteries. Initially, life style modification, risk factor modification or an exercise program will suffice. If there is evidence that arteriosclerosis is the cause of your problem and treatment is desired, painless ultrasound and Doppler tests may be ordered. These tests are often used to periodically monitor arteriosclerosis especially after intervention or surgery.  Occasionally, CT or MR scans are done to gain more information.  If treatment is desired and indicated, a diagnostic angiogram is done first to obtain a roadmap of the location and extent of the plaque before proceeding with the intervention to treat the plaque. These two parts are usually performed sequentially during the same procedure. They are invasive and costly procedures associated with ever-present but very small risks.

If I have arteriosclerosis, how can I prevent it from getting worse?

Arteriosclerosis is a slowly progressive arterial disease but the rate of progression can be influenced by our habits. The most important advice we can give you is to STOP SMOKING even though it’s hard to do. Eating less fat and reducing your cholesterol are helpful but are not as beneficial as giving up your smoking habit. Diabetics should control their glucose levels closely. Blood pressure medication, cholesterol lowering drugs and aspirin are commonly used to reduce the risk of problems caused by arteriosclerosis which can cause strokes, heart attacks and lower extremity problems. Unfortunately, your physicians cannot make your necessary life-style alterations, replace genes that may predispose you to arteriosclerosis but we offer advice and help. The recommended changes are up to each patient.

How will I know if the arteriosclerosis needs treatment?

With age, arteriosclerosis develops and worsens but it seldom needs treatment. If the artery narrowing or blockage limits your ability to exercise, prevents you from doing the things in your life that you wish to do, causes sores or gangrene, prevents sores from healing or causes pain at rest, treatment may be indicated. The mere presence of arteriosclerosis without these signs or symptoms is not an indication for interventional treatment. Remember that every medical intervention has some small risk and may not be as durable as desired.

If my lower extremity arteriosclerosis needs treatment, how is it done?

Hopefully, with medication and life-style changes your arteriosclerosis will never need treatment but if it does, it is treated very thoughtfully. It usually begins with a diagnostic angiogram which gives your doctor a roadmap of the location and severity of the artery problem. If the arterial problem is amenable to treatment balloons, which push the plaque out of the way, drills which grind the plaque into microscopic particles that wash away and stents which hold the treated area open may be used. These interventions occur following the diagnostic angiogram but during the same procedure. Sometimes, if the problem is not amenable to these endovascular interventions surgery may be recommended and scheduled at a later time. Surgery usually consists of cleaning out the artery or replacing it with a new tube which carries blood around the blockage. It is similar to plumbing.

This is general information and we encourage a full and thorough discussion with you and your family about your arteriosclerosis.