The Right Approach to Leg Pain
Many patients present to their physician with the complaint of leg pain. Sometimes it is a minor, self-limited injury. Often leg symptoms radiate from back pain or peripheral neuropathy in a diabetic patient, a far too common problem in South Texas. But leg pain, often associated with open ulcer wounds, could be from peripheral arterial disease (PAD).
This condition essentially results from inadequate blood being delivered to the muscles and skin of the legs and feet. Deciphering whether there is a vascular cause for leg pain certainly begins with a thorough history and exam, but when the diagnosis is unclear and may have a vascular etiology, it should make its way to the vascular surgeon for evaluation.
Arterial disease takes many forms. A sudden blockage of an artery can cause pain in an extremity corresponding to the level of the blockage. This is usually the result of an embolization from a more proximal part of the arterial circulation — such as the heart in atrial fibrillation or atherosclerotic aortic plaque. Adequately treating this condition requires rapid recognition, heparin anticoagulation and surgical embolectomy. Limb salvage is directly tied to how quickly the ischemia is reversed.
More chronic forms of PAD are intermittent claudication and ischemic rest pain. Patients with claudication have muscle pain, calf cramping and leg fatigue associated with walking. Symptoms abate when a patient stops to rest. A partial narrowing in an artery prevents adequate blood flow to muscles upon exertion yet allows enough flow at rest to preserve the tissues. The pain can be lifestyle limiting. Treatment begins with a dedicated three-month walking program to develop collateral circulation and cilostazol to widen blood vessels. Ischemic rest pain is foot pain that is always present and often associated with gangrene or ulcers of the feet and toes. Rest pain requires a more aggressive approach beginning with the vascular surgeon performing a minimally invasive catheter-based angiography to treat the blocked arteries. The vascular surgeon is also able to perform a surgical endarterectomy or bypass when indicated.
Leg pain is frequently caused by vein disease. Chronic venous insufficiency occurs when the valves within the veins do not close properly. Leg aches, pains, swelling, discoloration and ulcers may occur. Treatment, including graduated compression stockings and saphenous vein ablation, is directed at symptom relief. A deep venous thrombosis or blood clot is another common cause of acute leg pain. It is treated with anticoagulation and compression stockings but sometimes requires thrombolysis.
In the current era of highly specialized medicine, the best outcomes are achieved when a patient can get to a comprehensive expert initially. This specialist uniquely has the complete skill set to diagnose vascular disease and perform minimally invasive procedures and open surgery when needed.
To learn more about PVA or to schedule an appointment visit pvasatx.com or call 210-237-4444.