Alt extremity is studied under peripheral arterial disease. Not every peripheral arterial stenosis or occlusion needs intervention. Whenever the symptoms caused by vascular stenosis or occlusion leads to impairment of normal activity due to claudication or whenever there is critical limb ischemia manifested as alt extremity ulcer and signs of severe hypoperfusion, intervention is needed. Intervention may be surgical or percutaneous.
What are the symptoms of severe lower extremity disease?
Patients complain of lower extremity pain precipitated by walking and cannot walk enough distance without rest( claudication). Whenever there is critical limb ischaemia the pain may be present at rest, there may be signs of hypoperfusion like cold extremities, loss of hair, color changes and ulcers not easily treated. In the late stage because of neurologic disorder patients may not feel any pain or sensation.
Treatment
Patients with symptoms but without critical ischaemia are firstly treated with medical therapy which consist of antiaggregation and vasodilatator therapy and an exercise program. If symptoms persist despite this medication and lifestyle modification then the lesions are treated with balloon angioplasty and stent when needed.
In critical limb ischaemia peripheral angiography is indicated and the culprit vessel should be opened in order to restore tissue perfusion
Procedure:
In a catheter laboratory usually a catheter is inserted from femoral artery( sometimes the access site may be distal to the lesion- e.g. popliteal access in femoral artery stenosis), the culprit lesion is crossed by wires and angioplasty is done. Some sites are not suitable for stenting whereas others may be treated with stents. Stents are also used whenever there is complication after angioplasty( eg. dissection )