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Vascular disease: Frequently asked questionsThe following has been extracted from the Vascular Disease Foundation Web site. For more information, or to read more frequently asked questions, visit www.vdf.org. Q: My 46-year-old family member has had bypass surgery on each leg. The surgeons declare his surgery a success, yet intermittent claudication has returned. How common is continued leg pain after a successful bypass? What do you recommend for rehab and management of this type of condition? A: It is quite common for claudication to persist after surgery but ideally this symptom should be less severe. This is because it is usually not possible for the surgeon to bypass all of the many blockages that exist in patients with PAD. The ABI (ankle-brachial index) does not predict functional ability to walk since individuals with the same ABI may have very different walking limitations. Recommended care and management is to embark on an exercise rehabilitation program in a supervised setting. Such a program usually involves treadmill walking at least three times a week. Often these programs are administered by vascular specialists, or at the Vascular or Cardiac Rehab settings usually located in nearby hospitals. A vascular internist or cardiologist should supervise the care. Q: I was told that my ABI test was inconclusive because I have diabetes. What does that mean? A. ABI stands for ankle-brachial index and compares the blood pressure measured at the ankle to the pressure measured at the brachial artery, which is located in the arm. Diabetes can cause the artery wall to become calcified or hard and the blood pressure cuff cannot compress the artery to get a pressure, particularly at the ankle. As an illustration think of water flowing through a garden hose and a pipe in your home. You can bend the hose, but not the pipe. Calcified arteries are stiff, more like a pipe, and blood pressure measurements cannot be performed. Without an ankle pressure, there is no comparison for an ABI. When this occurs, often a toe pressure is compared to the arm, or the doctor may look at the waveforms from the Doppler ultrasound signal or from blood pulse volume. Q: My wife has an infection in her toe which has persisted for over a month. She had a Doppler exam of the right leg the other evening but it was negative. Still her doctor believes the problem is vascular. Is this true? A. Your wife's doctor is probably correct in suspecting that she has vascular disease. A foot ulcer or sore that does not heal can be a strong indication of PAD. It is possible that her arteries are narrowed or blocked and are not delivering a sufficient amount of blood to her feet. Not all cases of arterial disease will show up on Doppler tests or ankle-brachial index tests, especially if the arteries are hardened due to diabetes or normal aging. You can read about further tests under our Diagnoses section. We encourage you and your wife to continue working closely with her doctors and continue to ask good questions. Q: Should I be worried about varicose veins? How are these related to peripheral arterial disease? A. Varicose veins are caused by abnormalities in the veins themselves, a different part of the circulatory system, that returns blood from the body to the heart. Varicose veins are a form of vascular disease, but the causes and consequences of varicose veins are very different from PAD, and there is no relation between these two conditions. Q: I was told my veins are refluxing (opening and closing improperly) causing a burning pain in the back of my thighs. I feel this burning mostly when I menstruate and occasionally when I do a lot of walking. I was told surgery might help. Could this be PAD and if so what should I do? A. This is not PAD. Your veins return blood from your legs to your heart. Vein reflux means the valves, which help return blood, are not working correctly and leak. This is a relatively common problem in the superficial system of the veins in the legs and is associated with varicose veins. The deep veins may also reflux, which is more serious and may occur after deep venous thromboses (blood clots in the leg veins). The association with the menstrual cycle may indicate a condition called pelvic congestion syndrome, which can be associated with refluxing veins in the pelvic veins and can be associated with varicose veins. Pain in the back of the thighs is an unusual location for pain due to venous problems. It would be important to be absolutely sure that your symptoms are related to the pain in the back of the thighs before having surgery. It would be important to see a certified vascular surgeon in your area, particularly one who is a member of a major national society such as the American Venous Forum or the American Association for Vascular Surgery. Q: I was told I have peripheral neuropathy. Is this the same as PAD? A. No this is actually a group of nerve diseases affecting the nerves to the limbs Q. I have been told my "homocysteine levels" are high. What does this mean? A. Homocysteine is an amino acid. It is normally found in the body and is used to make protein. It is thought that too much homocysteine contributes to plaque build up and blood clot formation. High levels of homocysteine have been linked to increased risk for PAD and for damage to blood vessels in the heart and brain. Taking folic acid may reduce homocysteine levels, but it is not known whether folic acid prevents vascular diseases. Clinical trials are currently underway. It is important to discuss all options with your health care provider. Q: My sister has restless leg syndrome (RLS). Is this related to peripheral arterial disease? A. No, this is thought to be a neurological problem and not caused by atherosclerosis. The symptoms occur in the legs but are not the same as for PAD. RLS sensations are deep in the legs and produce an irresistible urge to move and cause an involuntary jerk of the leg. It usually isn't painful but can be described as an itching, pulling, or tugging. RLS symptoms are worse in the evening and at night, especially when the individual lies down.
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