Aches and Veins: Blockages in Arteries or Veins Have Painful Consequences
Pain in your legs while walking or exercising might be more than muscle strain. It could be a serious condition known as peripheral vascular disease (PVD).
“Claudication – which is pain in one or both legs during exercise that usually goes away when you stop exercising – is the primary early symptom of peripheral vascular disease,” explains St. Luke’s Chief of Cardiology Edward Kersh, M. D. “Signs of more advanced cases might include sores that won’t heal or, in extreme cases, gangrene.”
According to the American Heart Association, PVD affects more than eight million people in the United States, yet many of them do not have symptoms or they mistake the symptoms of PVD for something else. PVD is caused by blockages in the blood vessels that result in a loss of circulation to the body’s extremities, primarily to the legs and feet. People who have PVD are also more susceptible to heart attacks and strokes.
Peripheral Arterial Disease
“When people talk about PVD, they usually are thinking in terms of the arteries that carry oxygenated blood from the heart, although the veins that carry blood back to the lungs and heart are also vascular structures,” Kersh says. “Arterial disease is caused by a buildup of plaque deposits inside the arteries. This arteriosclerosis, or hardening of the arteries, can result in a narrowing or blockage of the arteries.”
Kersh notes that the risk factors for PVD are similar to those for heart disease and strokes. “The disease is most common among people who have diabetes, high blood pressure or high cholesterol,” he says. “Additional risk factors include smoking and a family history of the disease. It also seems to be more common in Asian-Americans and Hispanics.”
People who have any of the risk factors for arterial disease should be screened for the disease, even if they are not experiencing any symptoms. “Peripheral arterial disease can be a warning sign of potential blocked arteries in other areas such as the heart or the brain,” Kersh emphasizes.
Cardiovascular Risk Reduction Program at St. Luke's
The St. Luke’s Cardiovascular Risk Reduction Program (CRRP) offers comprehensive screenings, treatment recommendations and patient education for peripheral arterial disease, as well as heart disease and stroke.
“The first step in diagnosing peripheral arterial disease is to get a complete medical history on the patient,” says CRRP Program Coordinator Linne McAleer, ANP. “Then we do a simple, painless test called the ankle-brachial index. This test, which is done with the patient lying down, measures and compares the blood pressure in all four limbs. When the blood pressure is significantly lower in one or both legs than it is in the arms, it points to peripheral arterial disease.”
Another diagnostic test, called the CVProfilor®, measures the elasticity of the large and small arteries to detect hardening of the arteries. “St. Luke’s is currently the only San Francisco hospital that uses this test to guide patient treatment,” McAleer notes.
Additional tests may include sonograms that produce images of the blood vessels and angiogram imaging performed non-invasively with either CT or MRI scans.
Treatment of peripheral arterial disease includes making lifestyle changes to lower your risk factors:
- Stop smoking
- Control diabetes
- Control blood pressure
- Increase physical activity to improve circulation
- Eat a diet low in saturated fats and cholesterol
Various medications to control blood pressure and lower cholesterol may also be useful. For patients with more pronounced peripheral arterial disease, treatment might include angioplasty, a non-surgical procedure in which a “balloon” is inserted to open up narrowed or blocked arteries. Stents – cylindrical wire mesh tubes that keep the arteries open – also may be inserted non-surgically. If the patient’s condition is more severe, surgical removal of the blockage or artery bypass surgery may be required.
“Today’s treatments for peripheral arterial disease are very successful,” Kersh says. “The key, however, is to recognize that the presence of peripheral arterial disease means you have blocked arteries throughout your body, and you need to have your physician evaluate your heart and carotid arteries as well.”
Because they are thinner and more elastic than arteries, veins do not collect the cholesterol deposits found in hardening of the arteries. Nevertheless, veins can be subject to a variety of problems, too.
“Veins can develop blood clots that may have serious consequences,” says St. Luke’s Chief of Vascular Surgery Susan Bailey, M. D. “Deep vein thrombosis mainly affects the veins in the lower leg and thigh. A thrombus – or clot – forms in the larger veins of the area. This clot can interfere with blood flow, and it may break off and travel through the bloodstream to the brain, lungs, heart or other organs.”
Risk factors for deep vein thrombosis include prolonged sitting (such as on long plane or car trips) or extended bed rest. It also may be caused by recent surgery, fractures, childbirth, or the use of medications such as estrogen and birth control pills. Obesity, trauma to the legs and smoking are additional risk factors.
Various symptoms can be an indication of deep vein thrombosis:
- Pain or tenderness in one leg
- Swelling (edema) of one leg
- Increased warmth in one leg
- Changes in skin color (redness) in one leg
“Deep vein thrombosis is generally treated with blood-thinning medications and support stockings, rather than surgery,” Bailey says. “Other problems – such as collapsed veins, improper valve functioning and varicose veins – may require surgery.”
For more information about the St. Luke’s Cardiovascular Risk Reduction Program, please call (415) 695-7968.