Vascular Therapies

Claudication refers to muscle pain due to lack of oxygen that's triggered by activity and relieved by rest. Symptoms include the following:

• Pain, ache, discomfort or fatigue in muscles every time you use those muscles
• Pain in the calves, thighs, buttocks, hips or feet
• Less often, pain in shoulders, biceps and forearms
• Pain that gets better soon after resting

The pain may become more severe over time. You may even start to have pain at rest.

Signs or symptoms of peripheral artery disease, usually in more-advanced stages, include:

• Cool skin
• Severe, constant pain that progresses to numbness
• Skin discoloration
• Wounds that don't heal

Talk to your doctor if you have pain in your legs or arms when you exercise. Claudication can lead to a cycle that results in worsening cardiovascular health. Pain may make exercise intolerable, and a lack of exercise results in poorer health.

Peripheral artery disease is a sign of poor cardiovascular health and an increased risk of heart attack and stroke.

Other conditions involving the blood, nerves, and bones can contribute to leg and arm pain during exercise. It's important to have a complete exam and appropriate tests to diagnose potential causes of pain.

Claudication is most often a symptom of peripheral artery disease. The peripheral arteries are the large vessels that deliver blood to the network of vessels in your legs and arms.

Peripheral artery disease is damage to an artery that restricts the flow of blood in an arm or leg (a limb). When you're at rest, the limited blood flow is generally still enough. When you're active, however, the muscles aren't getting enough oxygen and nutrients to work well and remain healthy.

Damage to peripheral arteries is usually caused by atherosclerosis. This is the buildup of cholesterol and other fats, blood cells, and other cellular debris into abnormal structures (plaques) on the lining of an artery

Plaques cause a narrowing and stiffening of the artery, limiting the flow of blood. If the plaques rupture, a blood clot can form, further reducing blood flow.

The risk factors for peripheral artery disease and claudication include the following:

• Smoking
• High cholesterol
• High blood pressure
• Obesity (a body mass index, or BMI, over 30)
• Diabetes
• Chronic kidney disease
• Age older than 70 years
• Age older than 50 years if you also smoke or have diabetes
• A family history of atherosclerosis, peripheral artery disease or claudication

Claudication is generally considered a warning of significant atherosclerosis in the circulatory system, indicating an increased risk of heart attack or stroke. Additional complications of peripheral artery disease due to atherosclerosis include:

• Skin lesions that don't heal
• Death of muscle and skin tissues (gangrene)
• Amputation of a limb

The best way to prevent claudication is to maintain a healthy lifestyle and control certain medical conditions. That means:

• Quit smoking if you're a smoker
• Exercise regularly
• Eat a healthy, well-balanced diet
• Maintain a healthy weight
• If you have diabetes, keep your blood sugar in good control
• Keep cholesterol and blood pressure within normal values

Angioplasty is used to treat the buildup of fatty plaques in your blood vessels. This buildup is a type of vascular disease known as atherosclerosis.

Angioplasty may be a treatment option for you if:

• You have tried medications or lifestyle changes but these have not improved your leg pain.
• You have leg pain that is worsening.

Angioplasty isn't for everyone. Depending on the extent of your leg disease and your overall health, your doctor may determine that bypass surgery is a better option than angioplasty for you.

Although angioplasty is a less invasive way to open clogged arteries than bypass surgery is, the procedure still carries some risks.

The most common angioplasty risks include:

• Re-narrowing of your artery. When angioplasty is combined with drug-eluting stent placement, there's a small risk the treated artery may become clogged again (less than 5%). The risk of re-narrowing of the artery is about 10% to 20% when bare-metal stents are used.
• Blood clots. Blood clots can form within stents even after the procedure. These clots can close the artery. It's important to take aspirin in combination with clopidogrel (Plavix), prasugrel (Effient) or another medication that helps reduce the risk of blood clots exactly as prescribed to decrease the chance of clots forming in your stent.
  Talk to your doctor about how long you'll need to take these medications. Never discontinue these medications without discussing it with your doctor.
• Bleeding. You may have bleeding in your leg or arm where a catheter was inserted. Usually this simply results in a bruise, but sometimes serious bleeding occurs and may require a blood transfusion or surgical procedures.

Angioplasty is performed by a specialist and a team of specialized cardiovascular nurses and technicians in a special operating room called an angiography suite.

Angioplasty is performed through an artery in your groin, arm, wrist or ankle area. General anesthesia isn't needed. You'll receive a sedative to help you relax, but you may be awake during the procedure depending on how deeply you are sedated.

• You'll receive fluids, medications to relax you and blood-thinning medications (anticoagulants) through an IV catheter in your hand or arm.
• Your heart rate, pulse, blood pressure and oxygen level will be monitored during the procedure.
• Your doctor will prepare the area in your leg, arm or wrist with an antiseptic solution and will place a sterile sheet over your body.
• Your doctor will use a local anesthetic to numb the area where a very small incision will be made. A small, thin guidewire is then inserted in the blood vessel.
• With the help of live X-rays, your doctor will thread a thin tube (catheter) through your artery.
• Contrast dye is injected through the catheter once it is in place. This allows your doctor to see the inside of your blood vessels and identify the blockage on X-ray images called angiograms.
• A small balloon with or without a stent at the tip of the catheter is inflated at the site of the blockage, widening the blocked artery. After the artery is stretched, the balloon is deflated and the catheter is removed.
• If you have several blockages, the procedure may be repeated at each blockage.

Angioplasty can take up to several hours, depending on the difficulty and number of blockages and whether any complications arise.

You might feel pressure in the area where the catheter is inserted. You may also feel some mild discomfort when the balloon is inflated and your artery is stretched, but typically you shouldn't feel any sharp pain during the procedure.

Most people who have an angioplasty also have a stent placed in their blocked artery during the same procedure. A stent, which looks like a tiny coil of wire mesh, supports the walls of your artery and helps prevent it from re-narrowing after the angioplasty.

Here's what happens during a stent placement:

Stents implanted during an angioplasty are often drug coated. The medication in the stent is slowly released to help prevent future plaque buildup and the re-narrowing of the blood vessel.

After your stent placement, your doctor will prescribe medications, such as aspirin, clopidogrel (Plavix), ticagrelor (Brilinta) or prasugrel (Effient), to reduce the chance of blood clots forming on the stent.

• The stent, which is collapsed around a balloon at the tip of the catheter, is guided through the artery to the blockage.
• At the blockage, the balloon is inflated and the spring-like stent expands and locks into place inside the artery.
• The stent stays in the artery permanently to hold it open and improve blood flow to your heart. In some cases, more than one stent may be needed to open a blockage.
• Once the stent is in place, the balloon catheter is deflated and removed.
• More X-ray images (angiograms) are taken to see how well blood flows through your newly widened artery.

You generally should be able to return to work or your normal routine the week after angioplasty.

When you return home, drink plenty of fluids to help flush your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for at least a day afterward. Ask your doctor or nurse about other restrictions in activity.

Call your doctor's office or hospital staff immediately if:

• The site where your catheter was inserted starts bleeding or swelling
• You develop pain or discomfort at the site where your catheter was inserted
• You have signs of infection, such as redness, swelling, drainage or fever
• There's a change in temperature or color of the leg or arm that was used for the procedure
• You feel faint or weak
• You develop chest pain or shortness of breath

It's important that you closely follow your doctor's recommendations about your treatment with blood-thinning medications -- aspirin and clopidogrel (Plavix), prasugrel (Effient) or similar medications.

Most people who have undergone angioplasty with or without stent placement will need to take aspirin indefinitely. Those who have had stent placement will need a blood-thinning medication, such as clopidogrel, for six months to a year. If you have any questions or if you need any other type of surgery, talk to your interventional radiologist before stopping any of these medications.

Angioplasty greatly increases blood flow through the previously narrowed or blocked artery. Your leg pain generally should decrease, and you may be better able to exercise.

Having angioplasty and stenting doesn't mean your vascular disease goes away. You'll need to continue healthy lifestyle habits and take medications as prescribed by your doctor.

To keep your heart healthy after angioplasty, you should:

• Quit smoking
• Lower your cholesterol levels
• Eat a healthy diet that is low in saturated fat
• Maintain a healthy weight
• Control other conditions, such as diabetes and high blood pressure
• Get regular exercise
• Take medications as prescribed by your doctor

Successful angioplasty also means you might not have to undergo bypass surgery, a more invasive procedure that requires longer recovery time.