The questions patients actually ask.
Straight answers about peripheral vascular disease, angioplasty, stents, and the tests we run in our vascular lab — plus a plain-English glossary of the terms you are likely to hear.
If your question is not answered here, just call us — we would far rather answer it than have you wonder.
Peripheral vascular disease (PVD)
Peripheral vascular disease, or PVD, is a condition in which the arteries that carry blood to the arms or legs become narrowed or clogged, slowing or stopping the flow of blood.
The most common symptom is pain in the leg, particularly when walking. Other symptoms may include numbness, tingling and weakness in the leg. In severe cases patients may develop an ulcer, or sore, on the leg or foot that does not heal. Left untreated, ulcers can become infected, and in extreme cases untreated PVD can lead to gangrene — a serious condition that may require amputation of a leg or foot.
PVD is caused by atherosclerosis, or hardening of the arteries — a gradual process in which cholesterol and scar tissue build up inside the artery, forming a substance called plaque that clogs it. PVD symptoms can also develop when a blood clot forms in the artery.
It is not known for certain why PVD occurs. Contributing factors include smoking, high blood pressure, diabetes, high cholesterol, a family history of heart or vascular disease, and being overweight.
In some cases PVD can be successfully controlled by lifestyle changes, such as exercise programmes and dieting to lose weight and lower blood cholesterol. The single most important thing you can do to slow PVD is to stop smoking.
When lifestyle changes alone are not enough, there are several treatment options:
- Angioplasty. A very small balloon attached to a thin catheter is inserted into a blood vessel through a small nick in the skin and threaded under x-ray guidance to the blocked artery. The balloon is inflated to open the artery. In some cases a tiny metal cylinder, or stent, is left behind to keep it open.
- Thrombolytic therapy. Used when the blockage is caused by a blood clot. Clot-dissolving drugs are usually administered through a catheter directly into the clot, and are frequently combined with another treatment such as angioplasty.
- Bypass grafts. A vein graft from another part of the body, or a graft made from artificial material, creates a detour around the blocked artery.
- Thrombectomy. Used only when symptoms develop suddenly as the result of a blood clot. A balloon catheter is inserted beyond the clot, inflated, and pulled back, bringing the clot with it. This is usually performed as an open surgical procedure.
The best treatment depends on a number of factors, including your overall health, the location of the affected artery, and the size and nature of the blockage or narrowing. That is exactly what your consultation is for.
Angioplasty
Angioplasty is a medical procedure that opens up blocked or narrowed blood vessels without surgery. A very small balloon attached to a thin tube (a catheter) is inserted into a blood vessel through a very small incision in the skin, about the size of a pencil tip. The catheter is threaded under x-ray guidance to the site of the blocked artery. When the balloon reaches the blockage, it is inflated to open the artery, improving blood flow through the area.
Angioplasty can open your blocked artery, restore blood flow to your tissue, and relieve your symptoms without the need for surgery.
The most common reason is to relieve a blockage of an artery caused by atherosclerosis — hardening of the arteries — a gradual process in which cholesterol and scar tissue build up inside the artery, forming plaque that clogs it.
Arteries are like tubes; they carry blood and oxygen to the tissue in your body. When an artery becomes narrowed or blocked, the tissue it supplies does not get enough oxygen. The symptoms you feel depend on which artery is blocked. A blocked artery in the legs may cause pain when you walk, or even when you are resting in bed. A blocked artery to a kidney may cause high blood pressure.
Some blockages are best treated with surgery, while others are best treated with angioplasty. The procedure usually takes one to two hours; in some cases it may take longer.
Local anesthetic is used, so you will only feel some pressure during the procedure — as the catheter is placed into the blocked artery, the balloon is inflated, and the catheter is removed.
- Medication. Most people can continue to take their prescribed medicines. If you are diabetic and take insulin, ask your doctor about modifying your dose for the day of the procedure. If you take the oral anti-diabetic medicine Glucophage (metformin), you will need to stop it for up to 48 hours before and 48 hours after the procedure — consult your doctor about blood sugar control during this period. If you take a blood thinner such as Coumadin, you must tell your doctor so that it can be stopped. Bring all your medications with you.
- Allergies. If you are allergic to contrast (x-ray dye) or iodine, let your doctor know as soon as possible, so special precautions or medications can be arranged.
- Smoking. Do not smoke for at least 24 hours before your angioplasty.
In most cases you will stay in hospital after the angioplasty is completed. You will return to your room, and the nursing staff will let you know when you can eat and how long you need to stay in bed.
If you are returning home on the day of your angioplasty, you will stay in hospital for four to six hours afterwards. After this observation period you will be allowed to go home. Have someone drive you — you should not drive yourself.
With modern techniques, angioplasty is safer than surgery and complications are infrequent. However, because the procedure involves stretching one of your arteries and includes the use of catheters and contrast injection, there is some risk. Placing a catheter in your artery can damage the artery and may result in bleeding. Even when the artery has not been damaged, you may have a bruise or a small lump where the catheter was inserted; it may be sore, but will go away in a few days to a week.
Stents
A stent is a small, flexible tube made of medical-grade plastic or wire mesh. It is implanted in the body to treat a variety of medical conditions.
Through a very small incision in the skin, about the size of a pencil tip. The stent, placed on the end of a catheter, is threaded under x-ray guidance to the area of treatment. This technique is less traumatic than surgical implantation because it involves smaller incisions, less pain and shorter hospital stays.
Stents are used to treat a number of medical conditions. The most common use is to hold open clogged blood vessels after angioplasty. In some cases a stent is inserted to decrease the chances that the blood vessel will close up again.
ABI and artery testing
The ankle-brachial index (ABI) compares the blood pressure in your ankle with the pressure in your arm. It is quick, painless, and one of the best first looks at circulation in the legs.
If you have a note from your physician stating that you have no clots in your legs currently, then we can do the study. Otherwise, we cannot.
Yes. We take the pressure in the other arm and use that to formulate a ratio. When a patient has had breast surgery, lymph nodes under the arm are usually removed as well, and compression of the lymph system of the arm can lead to painful swelling for a long time — so we avoid that side.
This is most commonly seen in people with diabetes, though it may happen in others. Non-compressibility is due to vascular disease of the walls of the vessels, and it produces an abnormal reading.
Yes — that is a very good reason to have the test done. The correlation goes both ways. People who have an abnormal ABI are three to five times more likely to have coronary artery disease, and people who have heart disease are at higher risk for peripheral arterial disease as well.
Yes. The lower the ratio, the more severe the arterial disease. A ratio of 0.32 indicates more severe disease than an abnormal ratio of 0.75.
No. The ABI is for peripheral arterial disease only. Venous problems — deep venous thrombosis, phlebitis, varicose veins — are assessed with a separate venous duplex ultrasound, which we also perform in our vascular lab.
Terms you may hear, in plain English
Medicine has its own vocabulary. Here are the terms that come up most often in our consultations.
Vascular terms
An artery that bulges or protrudes from the arterial wall because the wall has weakened. An aortic aneurysm is a bulge in the aorta, the largest artery in the body.
Commonly called hardening of the arteries. Deposits of fatty substances, calcium, cholesterol, cellular waste and platelets build up in the inner lining of the artery wall, forming plaque that thickens the walls and costs them their elasticity.
A procedure in which a radiopaque contrast dye is injected into an artery and x-ray equipment identifies blockages and other abnormalities.
Cramping pain, usually in the legs, caused by poor circulation and a lack of oxygen reaching the muscles. It often creates a temporary limp and typically eases with rest.
The two carotid arteries in the neck supply blood to the neck, face and brain. Disease results when plaque builds up in their walls.
A blood clot in a deep vein, predominantly in the legs or pelvis and occasionally in the arms.
Commonly called a stroke. A CVA occurs when brain cells are damaged by a lack of oxygen — either because blood flow to the brain is blocked or because an artery to the brain ruptures.
When an artery becomes severely clogged or diseased, a healthy artery or vein from another area is grafted around the diseased section to improve blood flow.
Thoracic terms
A collapsed lung. It may be caused by lung tissue compressing, or by obstruction of the air passages — from obesity, fluid around or in the lung, foreign objects or tumors.
A procedure to view the airways of the lungs, performed by inserting a tube with a tiny camera on the end through the nose or mouth. Lung secretions or tissue specimens for biopsy may also be taken.
Chronic obstructive pulmonary disease — a group of lung diseases causing limited airflow due to swelling of the airways. Emphysema and chronic bronchitis are the most common forms. Smoking is a primary cause.
A surgical procedure for people with severely disabling emphysema. Removing the most severely diseased 20–30% of the lung allows the remaining tissue and surrounding muscles to work more efficiently, which can make breathing easier and improve quality of life.
Removal of a lobe within a lung when the lobe is cancerous or a lesion has been identified.
A surgical procedure in which a mediastinoscope is inserted through very small incisions to view the chest cavity. It is useful for examining the airways, masses or tumors, and allows surgeons to remove lymph nodes and test them for cancer or infection.
An alternative procedure that eliminates lung tumors using radiofrequency energy — heat. It is far less invasive than open surgery.
A condition in which the body perspires more than is needed to regulate temperature, often affecting the palms. It may be caused by an overactive sympathetic nervous system, which can be treated surgically.
This glossary is for education only and is not a substitute for advice from your own physician. If a term you were given is not here, bring it to your appointment and we will explain it properly.
Still have a question?
Ask a surgeon directly. We will go over your situation, what the tests show, and what your realistic options are.