By Jeffrey Edwards, MD, RPVI
Leg pain is frequently encountered by vascular surgeons and primary care providers alike. There are several potential etiologies with a wide array of treatment options, but determining the underlying cause is critical to successful diagnosis and treatment. Following a thorough history and physical, non-invasive testing options can be tailored to each individual patient. Vascular causes of leg pain are common and may be an indicator of systemic vascular disease. It is important to determine the underlying etiology of leg pain as there may be major implications pertaining to systemic cardiovascular health.
You may be familiar with the term angina, as it describes chest pain occurring due to restricted blood flow to the heart. This can be a warning sign for a heart attack. Similarly, claudication is a term used to describe pain in the legs which occurs with walking and may be a sign of underlying peripheral artery disease. This is a condition which results from blockages in the peripheral arteries, which are located in the legs (i.e., the vessels located outside of the heart and the brain). Major risk factors for peripheral artery disease include smoking, high blood pressure, high cholesterol, and diabetes. Initial treatment includes tobacco cessation, antiplatelet (aspirin) and cholesterol-reducing medications and an exercise program combined with a healthy diet. Up to 50% of people can improve their walking symptoms without the need for surgery. More severe symptoms or failure of conservative treatment may require a procedure or surgery to restore blood flow within the leg, such as minimally-invasive angioplasty or stenting, or in more advanced cases, traditional bypass surgery. This is when your vascular surgeon creates a new pathway for bloodflow around the blockages, either by using one of your veins or a prosthetic bypass.
Leg pain and claudication may also result from chronic venous insufficiency. Whereas the arteries carry oxygenated blood from the heart to the peripheral tissues, veins return the de-oxygenated blood to the heart and lungs after it has supplied oxygen to the muscles and tissues. Chronic venous insufficiency develops when venous blood no longer flows normally due to blockage or dysfunction of vein valves. The arteries rely on the heart to act as a pump to push blood through the vessels, but blood flow through veins is more passive. Vein valves normally prevent blood from refluxing or flowing backwards. If this occurs, pressure within the veins increases and fluid may leak into the surrounding tissues, leading to leg swelling and pain. In addition to these symptoms, unsightly darkening of the skin and varicose veins may also be present. Pain due to venous claudication can sometimes be distinguished from arterial claudication based on the patient’s history alone, as venous disease often results in pain associated with swelling, skin changes, and tends to be worse at the end of the day. Conversely, arterial claudication results in pain which is worse with walking and characteristically improves with rest.
Symptoms of leg pain and discomfort can be due to non-vascular causes. Spinal stenosis and degenerative disc disease can cause similar symptoms to vascular claudication; however this can be present with normal bloodflow. Important distinguishing features of neurogenic claudication include the sensation of “pins and needles” traveling down the leg, sometimes associated with shooting, shocking-type pain. It is not necessarily related to activity level and typically improves with sitting down or bending over at the waist. In this case, arterial and venous testing may be normal, and imaging of the spine is often recommended with x-rays or MRI. If pathology is identified, evaluation by a spine specialist would be recommended.
If you think you may be experiencing leg pain related to vascular disease, ask your doctor about a referral to a vascular surgeon. Sarasota Vascular Specialists is the only practice within the tri-county area dedicated solely to the treatment of patients with arterial and venous disease. Our board-certified vascular surgeons are nationally known and highly regarded experts in the treatment of all types of vascular pathology.
Sarasota Vascular Specialists
941-371-6565
www.veinsandarteries.com
Sarasota
600 N. Cattlemen Road, Sarasota, Florida 34232