Mayo Clinic Minute: How is peripheral artery disease diagnosed?

• By

  Alex Osiadacz

  September 1, 2022

Peripheral artery disease affects 8–10 million people in the U.S., most over age 65. But it also affects younger people who have additional risk factors, such as diabetes, smoking, obesity and high blood pressure. Also, 30% of Black Americans will develop peripheral artery disease, compared to 20% each from non-Hispanic white, Hispanic or Native American backgrounds.

Dr. Amy Pollak, a Mayo Clinic cardiologist, explains how physicians identify peripheral artery disease and why an early diagnosis can reduce the risk of amputation, heart attack and stroke.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads at the end of the post.  Please courtesy: “Mayo Clinic News Network.” Read the script.

Peripheral artery disease involves cholesterol buildup in arteries or blood vessels of the legs. The condition can restrict blood flow and lead to complications.

“Peripheral artery disease not only influences our ability to walk, but it puts us at a risk for amputation,” says Dr. Pollak. “And that also ties in with heart attack and stroke because of systemic cholesterol buildup.”

Diagnosing peripheral artery disease starts by checking circulation to the feet.

“Taking off the shoes and socks, doing a foot exam, feeling the pulses, and then, if you have somebody who either has symptoms that are concerning or an abnormal pulse exam, the next diagnostic test is something that’s straightforward to do,” says Dr. Pollak.

An ankle-brachial index test can identify circulation issues by comparing blood pressure in a person’s ankle to that in their arm before and after exercise. Tests and time with a health care team can promote conversations about the most appropriate medical treatment.

“Not only do we typically think of cholesterol medications, such as statins or the role of aspirin, but some of the other medications to help reduce that future risk,” says Dr. Pollak.

Related post:

• “Peripheral artery disease can signal cardiovascular trouble for heart, brain and legs.” 

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Symptoms in Legs, Lungs, and More

Written by WebMD Editorial Contributors

• Arms, Legs
• Heart
• Lungs
• Brain
• Belly
• Kidneys
• More

Ever get a paper cut or nick yourself while shaving? When that happens, a blood clot saves the day. It quickly stops the bleeding, and when it’s done its job, it usually breaks up. Sometimes, though, things can go wrong.

When blood clots don’t fall apart, they can be dangerous and lead to serious medical conditions. You can get them in blood vessels in just about any part of your body. They’re most likely to affect a leg, especially if you sit for long periods of time.

You might get a clot in your arteries, which carry oxygen in your blood from your heart to all the cells of your body. The result can be really serious. It can keep oxygen from getting to your heart, lungs, or brain, and cause a life-threatening emergency, like a heart attack or stroke.

You could also get a clot in the veins that carry blood back to your heart. When that happens, symptoms usually come on more gradually, but can still mean trouble.

If you learn the warning signs, you’re more likely to get quick medical help that can make a huge difference in keeping you out of the danger zone. But it’s important to know that in some cases, clots can happen with few symptoms or none at all..

See More: Dos and Don’ts of a Blood Clot

When a blood clot forms in one of the deep veins in your arm or leg, way beneath your skin’s surface, it could be something called a deep vein thrombosis (DVT). That’s dangerous because the clot could travel to your heart or lungs.

You’re more likely to get a DVT if you haven’t moved around for a long time, say after surgery or during a long plane trip. Get medical help right away if you notice any of these symptoms:

• Swelling. This can happen in the exact spot where the blood clot forms, or your entire leg or arm could puff up.
• Change in color. You might notice that your arm or leg takes on a red or blue tinge, or gets itchy.
• Pain. As the clot gets worse, you may hurt or get sore. The feeling can range from a dull ache to intense pain. You may notice the pain throbs in your leg, belly, or even your arm.
• Warm skin. The skin around painful areas or in the arm or leg with the DVT may feel warmer than other skin.
• Trouble breathing. If this happens, it could mean that the clot has moved from your arm or leg to your lungs. You may also get a bad cough, and might even cough up blood. You may get pain in your chest or feel dizzy. Call 911 to get medical help right away.
• Lower leg cramp. If the clot is in your calf or lower leg, you may feel like you have a cramp or charley horse.
• Pitting edema. DVT can cause fluid buildup (edema) in the arms or legs. It typically happens quite quickly with DVT. When you press on the swollen area, it can cause a dimple or “pit” (pitting) that remains for a few seconds.
• Swollen, painful veins. The pain may increase with touch.

A blood clot that forms in or around your ticker may cause a heart attack. Watch out for symptoms like these:

• Severe pain in your chest and arm
• Sweating
• Trouble breathing

A blood clot in your lung usually starts out in a deep vein in your arm or leg, then breaks off and travels to your lung. When this happens, you get what’s called a pulmonary embolism, an extremely dangerous condition.

Get medical help right away if you:

• Feel short of breath or have problems breathing
• Get pain in your chest
• Start to cough
• Begin to sweat
• Feel dizzy

Blood clots here may be caused by fatty deposits in the walls of the blood vessels that bring blood to your brain. Or sometimes, they may form because of a blow to your head that leads to a concussion.

In other cases, a clot that starts out in a different part of your body, like your chest or neck, might enter your bloodstream and travel to your brain, where it can cause a stroke.

Watch out for these symptoms:

• Problems with your vision or speech
• A seizure
• General feeling of weakness

Blood clots can happen in the veins that drain blood from your intestines. They can be caused by conditions like diverticulitis or liver disease, or even by birth control pills.

How will you know if this is going on? Check with your doctor if you have problems like these:

• Nausea or vomiting
• Severe pain in your belly, which may be worse after you eat
• Diarrhea
• Bloody stools
• A bloated feeling

A blood clot in your kidneys can keep them from removing waste from your body. That can cause high blood pressure or even kidney failure.

This is dangerous, so look out for these symptoms:

• Pain in the side of your belly, legs, or thighs
• Blood in your urine
• Fever
• Nausea or vomiting
• High blood pressure
• Sudden severe leg swelling
• Trouble breathing

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Complications of varicose veins: causes, symptoms, treatment

Considering varicose veins a cosmetic problem is naive. Varicose disease is a disease with all the signs inherent in any disease, often leading to severe complications. The main ones are:

Venous thrombosis is a blockage of a vein by a blood clot – a blood clot that prevents the normal movement of blood. The term “thrombosis” refers to the defeat of deep veins. One of the main causes of thrombosis is the slowing down of blood flow in the legs. The outflow of blood from the legs largely depends on the work of the calf muscles. Therefore, a decrease in physical activity (for example, bed rest) leads to a slowdown in blood flow and contributes to the formation of blood clots. In addition, in any situation associated with bleeding (surgery, trauma, childbirth), blood clotting increases. This defense mechanism keeps us from bleeding. However, increased coagulability also contributes to the occurrence of thrombosis. Clinically, thrombosis is manifested acutely, pain in the leg, aggravated by physical exertion, walking and swelling of the affected limb.

Of particular danger is pulmonary embolism – a condition when a detached blood clot blocks the lumen of the pulmonary artery – a vessel through which blood enters the lungs for oxygen saturation. Depending on the size of the thrombus, thromboembolism can proceed at lightning speed – death occurs in the first 30 minutes. A smaller thrombus does not kill immediately, but causes severe respiratory and circulatory disorders – pulmonary infarction and requires treatment in an intensive care unit. Thromboembolism of small branches of the pulmonary arteries is accompanied by the development of infarct pneumonia, chronic heart failure.

In most cases, the treatment of thrombosis is conservative. It is mandatory to bandage the leg with an elastic bandage or wear a special compression stocking. Blood thinners are also prescribed to help dissolve the blood clot. In many cases, it is possible to treat thrombosis on an outpatient basis, without hospitalization.

If, according to the results of an ultrasound examination, it is revealed that the thrombus is located in a large vein on the thigh, or there is a risk of fragmentation, separation of the thrombus and the development of pulmonary embolism, surgery is necessary.

Thrombophlebitis – inflammation of the wall of a superficial vein with the formation of a thrombus that closes the lumen of the vessel. Thrombophlebitis is manifested by redness and swelling along the inflamed thrombosed vein, pain of varying degrees of intensity. Around the thrombosed vein, the tissues are dense, swollen, and painful to the touch. In acute thrombophlebitis, an increase in body temperature is possible, sometimes with chills. Often, thrombophlebitis is called varicothrombophlebitis, thereby emphasizing once again that the main cause is varicose veins.

If thrombophlebitis is suspected, it is mandatory to conduct ultrasound diagnostics at the first visit of the patient. In most cases, thrombophlebitis is treated conservatively: compression therapy, drug therapy, topical application of ointments, etc. It is mandatory to bandage the leg with an elastic bandage or wear a special compression stocking. The need for surgical treatment arises when large veins are damaged, with a high probability of deep vein damage, separation of a blood clot.

Trophic ulcer – the inevitable outcome of varicose veins in the absence of treatment. As a result of impaired tissue nutrition and the inflammatory process, thickening of the subcutaneous tissue develops, thinning and darkening of the skin, followed by the formation of a trophic ulcer (such an ulcer exists for a long time, is resistant to treatment, and closes very slowly). Trophic disorders dramatically increase the duration of treatment and reduce its effectiveness. It should be noted that trophic disorders are not only for elderly patients.

About 15% of patients under the age of 40 in the presence of a pronounced lesion of large saphenous veins already have trophic disorders. A long course (sometimes for many months and years) of a trophic ulcer, combined with severe disorders of the tissues of the lower leg, leads to the development of skin lesions in the form of dermatitis, pyoderma, eczema. When a staphylococcal infection penetrates deep into the skin, diffuse pyoderma develops, accompanied by the appearance of purulent follicles and erosions. Prolonged violation of the skin of the lower extremities creates favorable conditions for the development of a variety of fungal lesions of soft tissues. One of the terrible complications of a trophic ulcer of the lower extremities should be considered malignant degeneration, which occurs in 1.6 – 3.5% of cases.

The approach to the treatment of trophic ulcers should be comprehensive. The choice of treatment method depends on the stage (phase) at which the ulcerative process is located. In each case, the duration of healing is different. Both conservative and surgical treatment is possible.

In most cases, conservative treatment is used – various dressings, membranes, multilayer wound dressings. This allows you to quickly remove inflammation, achieve cleansing of the ulcer, improve tissue nutrition, relieve the patient of pain, cope with eczema and weeping of the edges of the ulcer. Venotonic and tonic drugs, antibacterial and anti-inflammatory drugs are also used. A good effect is given by intermittent pneumocompression, bandaging, ozone therapy. Echosclerotherapy of varicose veins is also used, which reduces the healing time of the ulcer by 30%. All this contributes to the speedy healing of ulcers, reducing increased venous pressure, swelling of the lower extremities and improving microcirculation.

Surgical treatment for trophic ulcers reduces the risk of ulcer recurrence up to 8%. With conservative therapy, the risk of relapse is slightly more than 40% according to studies. The operation involves removing diseased veins that feed the ulcer. Plastic surgery can also be used to close the ulcer. This is done, as a rule, with extensive skin lesions.

Bleeding from varicose veins is a rather serious and sometimes life-threatening complication of varicose veins. Over long-existing varicose veins, the skin becomes thinner and the slightest injury can lead to bleeding.

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Causes and treatment of thrombosis | Articles – CDC “Arbatsky”

Have you noticed increasing redness? Bumpy bruises? Causeless stretching and burning pain in the legs? Do the movements bring discomfort and heaviness? This can only mean one thing – plugs form in the veins!

Let’s understand what thrombosis is on a simple example: imagine an ordinary city road, on which thousands of cars pass every day. There is a traffic light on it – an automatic traffic controller. Suddenly, trucks, KAMAZ trucks appear among the cars. The movement is still established, but already difficult. What happens on the road if the traffic light stops switching? Or will one of the lanes be suddenly blocked? Traffic jam! The same thing happens in the veins – from a sedentary lifestyle, injuries, drugs that thicken the blood and diseases, the blood flow in the veins begins to become difficult, and then the veins completely clog. This is how clots appear.

The state of thrombosis is caused by the accumulation of blood clots in the veins, which leads to a radical deterioration in health. There are two types of thrombosis: superficial thrombosis and deep vein thrombosis. The latter carries a significant risk to human life. Because it completely disrupts the blood flow in the affected vein.

Symptoms of thrombosis

The following general symptoms were identified: swelling of one or both legs, heaviness in the legs, pain, prolonged walking causes discomfort, cyanosis and redness of the skin. It is important to know that in patients who are predisposed to the formation of blockage of the veins, often there may be no symptoms of the disease at all. If you consider yourself to be in a group of people prone to this disease, then it is necessary to clarify whether you have venous thrombosis by specialists. Modern technologies allow timely detection of the disease at the initial stage of occurrence.

Factors predisposing to the formation of blockages and their number

The development of this disease is observed with a combination of factors such as:

• increased blood clotting activity;
• the speed of movement of blood through the veins decreases;
• possible damage to the venous wall;
• surgery with very long anesthesia;
• leg injuries and fractures;
• overweight;
• prolonged sitting or immobility;
• pregnancy or postpartum period;
• taking oral contraceptives containing estrogen.

Why is there an increase in the number of “car” traffic jams in the veins? The basis of venous disease is the fragmentation of venous thrombi. That is, with the advent of a single formation, the number of blood clots increases. This occurs up to the complete deprivation of the functioning of the affected vein. Blockage of veins by blood clots occurs in any veins. Often, the localization of thrombosis indicates the veins of the small pelvis and legs. The disease is always a threat to health.

Modern methods of treating thrombosis

Modern and conservative methods of treating vein blockage can significantly mitigate the course of the disease and prevent further development of resulting diseases. After the doctor ascertains vein thrombosis in the patient, one of the methods of treatment suitable for the patient is prescribed:

The doctor has identified mobile blood clots – strict adherence to bed rest and taking medications that promote blood thinning and, consequently, resorption of blood clots are prescribed.

The doctor suspects the risk of a blood clot detachment – an immediate surgical intervention is planned with the implantation of a temporary filter and the installation of a catheter that helps to liquefy the blood clot. After achieving the desired effect, the filter is opened and the catheter is removed. The operation is not burdensome for the patient. After the operation, a long period of observation and control of the filter functionality is carried out.

The doctor foresees the favorable removal of the thrombus using laser equipment – the removal of the thrombus is prescribed using non-drug intervention.

The doctor recommends removing the clot by skin puncture method – small punctures are made in the skin, the vein is sealed on both sides of the clot and the damaged part of the vein is removed.

The method of treatment is prescribed based on the obtained data on the size and location of the thrombus. Concomitant diseases, predisposition to thrombosis are taken into account.