Peripheral arterial disease is a condition where fatty plaque builds up in the arteries of the body and restricts the amount of blood that is able to flow distal to the plaque. This restriction in blood flow can cause a range of symptoms from mild pain when walking through to ulcers and gangrene.
Arteries take blood from the heart to all parts of the body, including the lower legs. Blockages can develop in your arteries due to a build-up of fatty plaque. The most common reasons for the build-up of plaque are:
These blockages then restrict the amount of blood flowing to the tissues beyond them. As you exercise the muscles of the leg require more blood. The result of the restriction in blood flow usually causes symptoms of pain when walking. As there is a progression of the disease the blood flow can be restricted to the point where patients experience pain when lying in bed at night. The end-stage of the disease is a situation where the blood flow is critically low that there is not enough oxygen reaching the tissues to keep them alive, this manifests as either ulcers, non-healing wounds or gangrene.

Management

Initial treatment for all patients presenting with peripheral arterial disease is good medical management, which usually involves
This treatment is aimed at reducing the risk of other complications of peripheral arterial disease such as heart attack or stroke.
The initial investigation for peripheral arterial disease is commonly an ultrasound scan. This may be accompanied by blood pressure measurements on the both the arm and leg. If these tests are inconclusive a CT scan may be required.
Peripheral aneurysm & Peripheral arterial disease
With the results of these scans Dr McGlade will be able to discuss with you and your family the location and extent of your arterial disease. Then depending on your symptoms and the severity of the occlusion he will tailor a treatment plan for your specific disease.
There are three treatment options for patients with peripheral arterial disease. These are exercise therapy, endovascular or minimally invasive surgery or bypass grafting.

Exercise therapy

Exercise therapy can be implemented in patient’s trying to avoid having surgical intervention. The aim of exercise therapy is to increase the blood flow around a narrowing or blockage by promoting the growth of small side channels called collateral vessels. The collateral vessels will increase the blood flow to the arteries beyond the blockage and if enough are able to be formed they can cause a complete resolution of the patient’s symptoms.

Endovascular surgery

This is a method of minimally invasive surgery performed via a needle in the groin. Wires are passed into the body under x-ray guidance and through the narrowing or blockage. Balloons are then able to be passed over the wires to stretch open the arteries and if needed a stent can be placed. There are other minimally invasive options including atherectomy which is a device that cleans out the plaque from the inside of the artery. Dr. McGlade has had advanced training in these techniques in the USA to enable him to offer them to a wider range of patients.

Bypass surgery

Peripheral artery bypass is a surgical procedure given with general anaesthetic to reroute the blood supply in your legs around a blocked artery.
Some patients are better served with bypass surgery. Bypass operations are usually more durable and longer lasting than the minimally invasive procedures.
Bypass surgery involves using a patient’s own vein or a prosthetic graft which is joined to the artery above and below the narrowing or blockage. This then allows blood to bypass the blockage and restore the flow to the lower leg.
Following this procedure most patients stay in hospital between 4-7 days. As this surgery improves your blood flow you may not have any more symptoms walking post-operatively, or are able to walk further distances than pre-surgery.
The prognosis is far better when medical conditions such as diabetes are stable and well controlled. Quitting smoking is very important to optimise results and limit complications.

Consultation

During your initial consultation with Dr. McGlade he will take a thorough history and examination. Then depending on the potential location and severity of your blockages further investigations may be required such as an ultrasound or CT scanning.