Blocked Leg Arteries, Antalya | Prof. Dr. Umuttan Doğan

Pain that starts in your calf as you walk and eases when you stop is usually put down to age or tiredness. In fact it is the most typical early sign of a narrowing in the leg arteries. Treating blocked leg arteries does not begin with a stent in every patient; a walking programme, giving up smoking and medication are the first step for most people. Peripheral angioplasty comes onto the table where those steps are not enough or the disease has progressed: the narrowed artery is entered through the groin, opened with a balloon and, if needed, supported with a stent.

What Is Peripheral Arterial Disease?

Hardening of the arteries does not affect only the heart. The same process goes on in the leg arteries; plaque builds up, the artery narrows and less blood reaches the muscle.

This is called peripheral arterial disease. “Peripheral” means away from the centre — that is, the arteries outside the heart.

At rest the leg muscles need little blood, and a narrowed artery can supply that. When you start walking, the muscle’s need rises several times over; the narrowed artery cannot meet the rise, and pain appears.

Leg Pain on Walking: the First and Most Important Sign

In medical language this is called claudication. Its typical features are:

It starts after you have walked a certain distance
It is felt in the calf, sometimes in the thigh or the buttock
It comes as cramping, burning or tiredness
It eases if you stop and wait a few minutes
It starts again at the same distance

That last point is what tells it apart. Pain from a slipped disc in the back eases when you sit down and bears no regular relation to distance; pain from the arteries eases while you stand still and resting, and comes back at the same distance every time.

Your walking distance shortening over time is the most concrete sign that the disease is progressing. “I used to walk to the shops easily, now I stop after two streets” tells you more than an examination does.

Warning Signs of Advanced Disease

The following should be assessed without delay:

Pain at rest. Pain that starts in the toes, particularly at night when you are lying down. It typically eases when you hang the foot over the side of the bed.
A wound that will not heal. A sore on the foot or the toes that has not closed for weeks.
A change in colour. Pallor, a bluish tinge or darkening of the foot.
Coldness and numbness. One leg being noticeably colder than the other.

These findings show that the blood reaching the leg is not enough even at rest, and they call for assessment as a priority.

Who Is It Seen in More Often?

Smokers. This is the strongest risk factor of all for the leg arteries.
People with diabetes. It affects the arteries below the knee in particular.
Older age
High blood pressure and high cholesterol
Chronic kidney disease
Anyone who has had a heart attack or a stent before

How Is It Diagnosed?

The Ankle-Brachial Index (ABI)

Most patients have never heard of this test, yet it is the most valuable first step.

It is done with a blood pressure cuff and a small Doppler device: the pressure measured at the ankle is divided by the pressure measured at the arm. Normally that ratio is around 1. Where the leg arteries are narrowed, the pressure at the ankle falls and the ratio comes down.

It takes a few minutes, needs no needle and uses no radiation. Where there is a suspicion, this is the first thing to do.

The other methods:

Doppler ultrasound: shows where the narrowing is and how the blood is flowing.
CT angiography: maps the leg arteries; used in planning a procedure.
Angiography: gives the definitive picture, and treatment can follow in the same session if needed.

What Is the First Step in Treating Blocked Leg Arteries?

This section corrects what is most often misunderstood on this subject.

In patients who have pain on walking but no signs of advanced disease, the first step is not a procedure. International cardiology guidelines recommend the following first in this group:

Giving up smoking completely. It is the single most effective step that can be taken for the leg arteries.
A regular walking programme. Walk until the pain comes, rest, walk again. Walking distance can increase over time; the body develops collateral routes for the circulation.
Cholesterol-lowering treatment and a blood thinner.
Control of diabetes and blood pressure.
Foot care. A daily check, particularly in people with diabetes.

A procedure comes onto the table in patients whose symptoms persist despite these steps, or who have signs of advanced disease. Putting a stent into every narrowing is not the right approach.

When Is Peripheral Angioplasty Needed?

Where pain that limits daily life persists despite medication and a walking programme
Where walking distance is falling markedly over a short period
Where pain has begun at rest
Where there is a wound on the foot that will not heal, or tissue loss
Where, because of your work or the way you live, the limit on your walking cannot be accepted

Balloon or Bypass?

Once a procedure is decided on there are two routes, and the choice does not rest on a single criterion.

Opening it with a catheter (peripheral angioplasty): done through the groin, with no incision and a short recovery. It comes to the fore in short and medium-length narrowings, in disease below the knee, and in people at high surgical risk.
Bypass surgery: the artery above and below the blocked segment is joined using one of the patient’s own veins or an artificial graft. It is considered in very long blockages, in anatomies where the catheter method is not suitable, and where a procedure done earlier has not worked.

The decision takes into account the length and site of the blockage, how calcified the artery is, the state of the arteries below it, your age, the other conditions you have and your surgical risk.

The two are not rivals in treating blocked leg arteries. If the catheter method does not work, bypass may come onto the table; and a narrowing that develops after a bypass can be opened with a catheter. In complex cases the decision is reached through a process in which cardiology and cardiovascular surgery give their opinion together.

How Is the Procedure Done?

The procedure is done under local anaesthetic, usually through the artery in the groin. Once the arteries have been mapped, a guidewire is passed across the narrowing, a balloon is inflated and a stent placed if needed.

The Arteries Above the Knee

The arteries in the thigh are wider and suitable for a stent. Both balloons and stents are used in this segment.

The Arteries Below the Knee

The arteries below the knee are narrow and lie in a part of the body that moves. A stent is not always suitable there.

For that reason drug-coated balloons are mostly preferred in procedures below the knee. As the balloon opens the artery it leaves a drug on the surface; the drug helps delay the artery narrowing again, and no permanent metal is left behind.

Disease below the knee is particularly prominent in people with diabetes, and treating it calls for its own approach.

Afterwards

Pressure is applied at the access site for a period and it is watched. How long you stay in bed depends on the method used. Discharge is planned for the same day or the next in most patients.

The Diabetic Foot and Blocked Arteries

In people with diabetes, foot wounds come about through two causes together.

The first is nerve damage. Because sensation in the foot is reduced, a small injury goes unnoticed; feeling no pain, the person carries on walking on it.

The second is a blocked artery. For a wound to close, enough blood has to reach the area. If the artery is blocked, the wound will not close whatever is done.

So with a foot wound that will not heal, wound care on its own is not enough; the arteries need to be assessed. Once the blood flow is there, wound care becomes meaningful.

Blockages in the Arm Arteries

Peripheral arterial disease brings the legs to mind, but the same process can affect the arm arteries too. This is seen less often and is frequently missed.

The warning signs:

A difference in blood pressure between the two arms. It is the most concrete sign found on examination. If the reading in one arm is markedly lower, it should be looked into.
Tiredness or pain when you use the arm. It is the arm’s equivalent of claudication in the leg; it can appear while you are combing your hair or painting.
Dizziness when you work the arm. Blood going to the arm may be being drawn away from the artery that supplies the brain.
Coldness, pallor and a weak pulse in the hand.
Problems with a fistula in patients on dialysis. A narrowing in the arm arteries can stop the fistula working properly.

Narrowings in the arm arteries can also be opened with a catheter, using a balloon and a stent, much as in the leg. The assessment follows the same reasoning.

If Your Leg Artery Is Blocked, Your Heart Should Be Assessed Too

Hardening of the arteries does not stay confined to one part of the body. In someone found to have a marked narrowing in the leg arteries, there is a high likelihood that the same process has affected the arteries of the heart and the neck as well.

A diagnosis of peripheral arterial disease is therefore a reason to assess the heart, not only the leg. Even if you have no symptoms, the state of your coronary arteries is reviewed.

The reverse holds too: where a patient with a stent in the heart has leg pain on walking, that should be looked into rather than put down to age.

What Are the Possible Risks?

Bruising, bleeding or injury to the vessel at the access site
A temporary effect on kidney function from the contrast dye; your kidney results are assessed beforehand
Injury or a tear in the wall of the artery
A clot or a fragment of plaque passing down into the arteries below
The treated segment narrowing again over time

The risks are weighed against the benefit expected from the procedure and discussed in detail for your own situation at the consultation beforehand.

After the Procedure

Blood-thinning treatment is followed regularly for the period your doctor sets. Do not stop the medicines on your own.
Smoking is given up. In an artery that has been treated, smoking is the strongest cause of it narrowing again.
The walking programme continues after the procedure. The procedure opens the artery; walking builds the capacity of the muscle.
Control of cholesterol, diabetes and blood pressure is maintained.
The feet are checked daily; this matters particularly in people with diabetes.
You are reviewed at set intervals, with Doppler ultrasound if needed.

If you notice your walking distance falling again, pain at rest or a new wound on your foot, see your doctor without waiting.

Treating Blocked Leg Arteries in Antalya

Prof. Dr. Umuttan Doğan is a cardiologist whose work covers the interventional treatment of the arteries of the arms and legs, together with complex coronary procedures. Peripheral angioplasty is carried out in the catheter laboratory at Antalya American Hospital.

If you have leg pain on walking, a foot wound that will not heal, or a peripheral angiogram has been suggested to you, you can be seen at the clinic in Konyaaltı with the tests you already have. For the other vascular procedures see the peripheral vascular interventions page. You will find his background and contact details on their own pages.

Frequently Asked Questions

It hurts when I walk but eases when I rest. Is it urgent?

It is not urgent, but it should be looked into. This is the typical early sign of peripheral arterial disease and can be assessed with a simple measurement. What should not be left is pain that is there at rest as well, or a wound on the foot that will not heal.

Is treatment possible without a stent?

In many patients, yes. For people who have pain on walking and no signs of advanced disease, the first step is giving up smoking, a regular walking programme and medication. A procedure is considered in patients whose symptoms persist despite those steps, or whose disease has progressed.

Are stents put into the arteries below the knee as well?

Because the arteries below the knee are narrow and lie in a part of the body that moves, a stent is not always suitable. Drug-coated balloons are mostly preferred in this segment; the artery is opened, a drug is left on the surface and no permanent metal remains.

Can an artery that has been opened block again?

It can. A procedure opens the narrowing but does not stop the process that hardens the arteries. If smoking continues, and cholesterol and diabetes are not under control, the likelihood of it narrowing again rises markedly. This is why medication and regular review are an inseparable part of the procedure.

My foot wound simply will not close. Could my arteries be involved?

They could. For a wound to close, enough blood has to reach the area. If the artery is blocked, wound care on its own will not work. With a foot wound that will not heal, the leg arteries need to be assessed.

The information on this page is for general guidance and does not replace a consultation. Decisions about diagnosis and treatment are made by your doctor after assessing your own situation.