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Arterial Occlusive Disease, Lower Extremity

What is Lower Extremity Arterial Occlusive Disease?

Atherosclerosis, or hardening of the arteries is caused by the accumulation of a fatty substance called plaque on the inside of the walls of arteries, is a condition that affects up to 35% of Americans. Atherosclerosis can cause narrowing of any of the arteries throughout the body. This narrowing or occlusion is called stenosis, and can occur in the arteries in the (the legs), or more infrequently in the arms. When it occurs in the legs and feet, it causes a disease known as lower extremity arterial occlusive disease.

Narrowing of the arteries in the lower extremities of the body decreases the blood supply to the muscles and tissues in the surrounding area (poor circulation). Lower extremity arterial occlusive disease is often present in conjunction with other conditions, such as carotid artery disease and heart disease. Risk factors for lower extremity arterial occlusive disease include family history of atherosclerosis, high blood pressure, diabetes, high cholesterol, and advanced age, as well as factors such as a sedentary lifestyle and smoking. Smoking is the number one risk factor for cardiovascular diseases.

How is Lower Extremity Arterial Occlusive Disease Diagnosed?

The symptoms of lower extremity arterial occlusive disease include:

  • Pain in the calves or thighs while walking (claudication)
  • Pain in the feet at rest
  • Coolness of legs and feet
  • Poor healing of wounds in the extremity
  • Ulcers of the feet and legs
  • Black discoloration of the toes or skin (gangrene)

Claudication is the most common symptom of lower extremity arterial occlusive disease. Some people may also experience numbness, weakness, or cold in the feet or legs. As the disease progresses, pain may also be felt at rest in the toes. The skin around the occluded artery may become discolored, and ulcers may develop, which can turn gangrenous if untreated. The development of ulcers indicates that the blood supply to the muscles and tissues in that area has been cut off.

In order to determine the severity of the condition, the doctor will conduct a blood pressure test comparing the blood pressure measurement in the ankle to that in arm. The result of this test, called the ankle brachial index (ABI) will evaluate the extent to which the blood supply is limited in the leg.

Imaging tests may also be necessary to determine the location and the extent of the arterial narrowing (stenosis) in the legs. These tests may include angiography or Magnetic Resonance Imaging (MRI).

How is Lower Extremity Arterial Occlusive Disease Treated?

If symptoms are mild to moderate, the disease can be well managed by lifestyle changes such as a smoking cessation, regular exercise, and management of related conditions such as diabetes, high blood pressure, and cholesterol levels. Exercise can help tremendously in relieving symptoms. Blood-thinning drugs or other kinds of medication may also be prescribed.

In some cases, a procedure may be required to relieve the narrowing in the artery and restore blood flow to the leg. The arterial stenosis may be treated using minimally invasive procedures such as angioplasty and stenting to improve blood supply to the extremity.

However, if the disease is very advanced, or if it occurs in an artery that is difficult to reach with a catheter, arterial bypass surgery may necessary in order to restore blood flow.

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