SPRINGFIELD — Do you suffer from leg pain? Although most leg pain and muscle cramps are harmless, some may be related to an underlying medical condition known as peripheral arterial disease (PAD), requiring evaluation by a vascular surgeon.
Peripheral arterial disease in the legs or lower extremities is the narrowing or blockage of the vessels that carry blood from the heart to the legs. It is primarily caused by the buildup of fatty plaque in the arteries, which is called atherosclerosis. PAD can happen in any blood vessel, but it is more common in the legs than the arms.
“Vascular surgery is one of the least understood medical specialties because what we do is so varied,” said Dr. Hazel Marecki of Baystate Vascular Services. “We treat diseases of the arteries, veins, and lymphatics throughout the body except the brain and heart. We take ownership of the medical aspects of this care as well because it so closely relates to the pathology and to our outcome.”
The body’s cardiovascular, or circulatory, system is made of the heart, blood, and blood vessels (arteries and veins). In general, arteries carry blood away from the heart, and veins carry blood back to the heart. The cardiovascular system delivers oxygen, nutrients, hormones, and other important substances to cells and organs in the body. It plays an important role in helping the body meet the demands of activity, exercise, and stress. It also helps maintain body temperature, among other things.
“Patients commonly see us for issues with arterial blockages such as those in the neck involving the carotid artery, which can cause stroke if not treated, or in their legs that can cause pain when they walk or contribute to ulcers that do not heal on their feet,” Marecki said.
Additionally, vascular surgeons treat aneurysms of the belly and chest, varicose veins, deep vein thrombosis, creation and maintenance of dialysis access, as well as many other conditions affecting the blood vessels.
When it comes to PAD, Marecki noted there are many causes of pain in the leg, and not all are due to blood vessels. “If it is more centered around joints or positioning of your leg, then it is likely to be more of a musculoskeletal problem. If it is related to vascular disease — it is something that only happens when you walk or exercise, for example — if you feel cramping walking up the stairs, that is enough to make you stop in your tracks. That is often the first sign of low blood flow to your leg.”
Doctors test for low blood flow by performing a blood-pressure check of the foot called the ankle-brachial index test.
“By listening to the pulse and hearing when it goes away and comes back, we can tell how much arterial blood flow is getting to the leg,” Marecki said.
She noted one of the best treatments for many people with PAD, despite the fact that it hurts, is to actually walk more, and to work with a doctor to develop a structured walking program. “Consistent walking helps to grow new pathways down to the leg, called collateral arteries, which increase blood flow.”
Medications may also be prescribed to protect the heart, since leg pain can be indicative of heart issues, she noted. These medications may include antiplatelets such as aspirin to prevent blood clots from forming and narrowing arteries even further, statins to lower cholesterol and certain fats in the blood, and ACE inhibitors or other medicines to lower blood pressure and prevent blood vessels from narrowing.
If the patient is still having serious leg pain after lifestyle changes, an exercise program, and medication, Marecki said surgery is an option. “We use an imaging test called an arteriogram, which allows us to see inside the blood vessels of the leg to determine if there is a blockage. If there is, we can perform angioplasty, a minimally invasive procedure, to open narrowed or blocked arteries.”
As part of the procedure, the surgeon may inflate a small balloon in the artery to flatten the plaque. Sometimes the balloon is coated with medicine to help the artery heal. The doctor may also insert a small mesh tube called a stent to reduce the chances that the artery will narrow again.
Bypass surgery may be used to treat severe pain, heal wounds, or save a damaged foot or leg when angioplasty is not as likely to work. In this procedure, a piece of another blood vessel from the body or an artificial vessel is used to create a new path around a blocked artery in the leg.
Of the numerous risk factors for PAD, smoking is number one: the risk for smokers and former smokers is two and a half times higher than it is for non-smokers. Other common risk factors include being over age 50; diabetes, especially for those with long-term insulin dependence; chronic kidney disease; previous heart attack; family history of PAD; high blood pressure; high cholesterol; and blood-clotting disorder.
Heart-healthy lifestyle changes that are often recommended to treat PAD include quitting smoking, choosing heart-healthy food, aiming for a healthy weight, getting regular physical activity, and managing stress.