Peripheral Vascular Disease (PVD)

Leg symptoms vary among patients.  They can include a tired or heavy feeling in the buttock, thigh or calf as well as calf or buttock cramping when walking or exercising.  More advanced disease presents with discoloration of the toes, pale or even cold feet.  Numbness or tingling in the toes or feet can occur.  On physical examination decreased hair growth on the legs is frequently seen and occasionally ulcers develop on the legs and feet, particularly the toes.  In addition to cessation of smoking, controlling diabetes and diet, a supervised exercise program can help limit the patient’s symptoms.  But, when the symptoms of PVD fail to respond to these measures, further treatment may be needed. 

The following illustrations demonstrate interventional radiologic treatment in a 55-year-old female patient with bilateral calf claudication greater on the right than the left which occurred after walking approximately 20 yards. In addition, the patient also complained of right buttock claudication walking short distances. Although the symptoms ceased after resting five minutes, they again returned after walking an additional 20 or so yards. 

Noninvasive vascular testing performed revealed evidence for arterial occlusive disease in both legs greater on the right than left.  A diagnostic angiogram was performed in an attempt to obtain a “road map” of the extent of arterial occlusive disease and to
figure
determine whether endovascular treatment or bypass surgery would be appropriate in this patient.  The angiogram demonstrates a high grade stenosis in the right common iliac artery and a mild stenosis in the left common iliac artery (Figure 1).

After discussing these findings with the patient, the patient’s family physician, and the patient’s vascular surgeon, it was decided  that treatment using interventional radiologic techniques could provide the simplest and safest treatment.  Using balloon catheters and metal stents, the iliac arteries were successfully opened (Figure 2) providing excellent blood flow to both legs.  The patient left the hospital the following morning, able to walk without claudication in either leg or buttocks.
figure