Arterial Doppler

About Lower Extremity Arterial Disease
Lower extremity arterial disease, is the result of a buildup of cholesterol and plaque deposits on the walls of the arteries. Plaque buildup causes the lining of the arteries to become rough, thickened, narrowed or blocked, which leads to decreased blood flow in the legs.

Symptoms depend on the location and extent of narrowing of the artery or arteries. The most common symptom is claudication. Claudication is a pain in the hips, thighs or calves that occurs after walking a certain distance and is alleviated with rest.

As the arteriosclerosis or arterial narrowing progresses, an individual may experience pain in the toes and feet. This is called "rest pain" and occurs because the body is unable to deliver enough blood to the feet at rest. Other symptoms include decreased hair growth on the legs, numbness, tingling, cool temperature of the foot and leg and a sore on the heel of the foot that does not heal. As the blood flow to the foot is further reduced and unable to meet the nutritional needs of the tissue, gangrene or death of the tissue can result.

Risk Factors
Significant narrowing of the arteries is more common in people over the age of 45. Risk factors include:

• smoking
• high cholesterol
• high blood pressure
• diabetes
• heart disease
• family history of arterial disease
• obesity

Reducing Your Risk

• Tobacco in any form should be avoided. Not only does it increase the risk of arteriosclerosis, but nicotine also causes blood vessels to constrict and further restricts the already reduced blood flow.
• Reduce cholesterol and saturated fat in your diet by avoiding egg yolks, red meat, dairy products containing fat and plant oils, such as coconut and palm oil. Polyunsaturated fats such as corn and safflower oils are recommended.
• Blood pressure should be checked regularly and controlled with medication when necessary. (Patients with high blood pressure may not have any symptoms.)
• Early detection and careful management of diabetes.
• Exercise such as walking until you develop leg pain is encouraged. This will condition your muscles and improve your exercise tolerance. Vigorous exercise is not necessary.
• When blood flow to the legs is decreased, small injuries to the feet or toes may result in serious infections, sores or tissue death (gangrene). Protect your foot health by:
  
  
  • wearing proper fitting shoes
  • avoiding bare feet
  • practicing good hygiene
  • washing and drying feet thoroughly
  • avoiding exposure to extreme heat or cold
  • seek supervised treatment for any infection or ulcers of the foot

Diagnostic Techniques
There are two types of techniques currently available for diagnosing lower extremity arterial disease—invasive and noninvasive. Noninvasive tests do not require the use of needles, dyes or x-rays. They are painless, have no known risks or side effects, do not require special preparation and can be performed on an outpatient basis. Invasive tests on the other hand do require preparation, needles and more.

Noninvasive Tests
The arterial Doppler exam is a noninvasive exam that uses a device called a Doppler to make recordings of the arterial pulse at various points along the arteries in the leg. Blood pressure is also measured at different points along the arteries. (Blood pressure will be proportionately reduced beyond a significantly narrowed or blocked artery.)

From these tests, the location and severity of your disease can be determined.

The photoplethsmography (PPG) technique, another noninvasive exam, helps physicians examine very small arteries in the legs,such as toe arteries, that may be affected in diabetic persons. Photoplethsmography (PPG) uses light to detect the amount of blood flow in the soft tissue of the toes.

Duplex scanning uses ultrasound to produce images of a vein or artery. In this procedure, a technician applies gel and a probe to evaluate the blood flow in the arteries. Imaging of leg veins may be performed to evaluate whether they are suitable for a by-pass graft if one is deemed necessary.

Invasive Tests
An arteriogram is an invasive procedure that is usually performed prior to making a decision regarding surgery or angioplasty. In an ateriogram, a dye is injected into an artery through a catheter. Images are then made of the artery or arteries.

Preparation
The arterial Doppler procedure takes approximately one hour to complete. There are no special preparations for this test.

Results
Test results are forwarded to your physician within three to 5-7 work days. You may wish to follow up with your physician to discuss your results.

Treatment
The treatment of lower extremity arterial disease depends on your general condition, your signs and symptoms, results of the test and your physician's recommendation. Mild disease may be treated by:

• eliminating the use of tobacco
• implementing an exercise program which may help to improve the collateral flow and condition the muscles
• following a low fat diet

The treatment of severe or progressive disease may require one of several procedures or operations. Your doctor will explain your options based on the results of your test. Balloon angioplasty or by-pass surgery are procedures commonly used to treat hardening of the arteries.

In balloon angioplasty, a catheter with a balloon at its end is placed in the artery at the area of narrowing. The balloon is inflated to brake up plaque, thereby making the arterial lumen wider. By-pass surgical procedures involve the use of your own leg veins or a synthetic graft to by-pass the diseased arterial segment. Both procedures improve the blood flow to your leg and alleviate symptoms, but do not cure arteriosclerosis.