Text for the Peripheral Artery Disease Brochure

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What is Peripheral Artery Disease?

Peripheral Artery Disease is caused by a thickening of the inside walls of the arteries of your legs. This thickening, called atherosclerosis (ath a row skle row sis), narrows the space through which blood can flow, decreasing the supply of oxygen and nutrients to the leg muscles.

Atherosclerosis usually occurs when a person has high levels of cholesterol, a fat-like substance, in the blood. Cholesterol and fat, circulating in the blood, build up on the walls of the arteries. The buildup narrows the arteries and can slow or block the flow of blood. When the level of cholesterol in the blood is high, there is a greater chance that it will be deposited onto the artery walls. This process begins in most people during childhood and the teenage years, and worsens as they get older.

Right now your symptoms suggest that you have peripheral artery disease. If that is the case, your doctor will recommend changes in your lifestyle, possibly medications, and possibly procedures to improve blood flow to the leg muscles. But first it's important to confirm that your symptoms are caused by blockages in the arteries of your legs. If there are blockages, it's important to see just how serious the blockages are. All this can be done with an angiography.

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What is an Angiography ?

An angiography is a remarkable type of procedure that allows doctors to use an X-ray camera outside your body to see how blood circulates within the vessels of your legs. This is accomplished with only one small incision, at the very top of your leg. Through this incision, a very small tube - a catheter -- is threaded to where the problem seems to be. There, X-ray dye is released, which your doctor will watch on special television monitors. If the X-ray dye does not reach areas that it should, that means that your blood also isn't reaching those areas. Depending on circumstances, your doctor may feed medications through the tube directly to the spot, or he may even expand a miniature balloon in the area of the blockage, to push back the buildup and help your blood circulate properly again. All this is accomplished through a cut so small that it typically does not even need one stitch to heal properly.

Before Your Angiography:

Although an angiography is not surgery, there are a few guidelines that need to be followed. Please do not eat any solid food the morning of your appointment. You may drink clear liquids, and you may continue to take any medications that your doctor has prescribed.

Since you will not be allowed to drive after the procedure, arrange for transportation to and from our facility.

Please be on time for your appointment, since there's lots to do. Some last-minute paperwork will need to be completed. Then it's time to change into a hospital gown. We will draw a small sample of your blood, for lab work, and we will place an IV in your arm. As we're about to go to the lab, we'll add a medication to your IV that will help you to relax.

During the Procedure:

Dr. Welby will join us in the lab. Although you'll feel groggy, you will be awake, and able to speak with him.

The large machine hanging from the ceiling is the X-ray camera. What makes this machine unique is that, instead of a single snapshot, like a traditional X-ray, this machine takes pictures continuously. These pictures are displayed on the monitors next to you, and they are also filmed, for later review.

The procedure begins with a very small incision, at the top of your leg. Through this small cut a tube, not much thicker than a pencil lead, is threaded into the artery that takes blood to the leg you're having a problem with. Watching on the TV monitor, Dr. Welby can tell exactly when the end of the tube is where your blockages might be. Once in place, a small amount of X-ray dye is released through the tube. This liquid flows exactly like your blood should flow - what makes it different is that it's visible on the camera. If the X-ray dye does not circulate through your leg completely, we know there are blockages, and we know where they are.

Correcting the Problem:

Your angiography is a procedure to help identify the problem - it is not a treatment. Sometimes your treatment will be as simple as feeding special medications through the tube, while it's in place. Other times the treatment is what's called an angioplasty. During an angioplasty a very small uninflated balloon is fed through the tube. The balloon is positioned where the blockage is, then inflated. When the balloon is inflated, it pushes the build-up in your vessel back against the walls, widening the vessel once again. Sometimes miniature wire scaffolds, called stents, are pushed into place against the walls of the vessel, to help keep it open. Whether one or more of these treatments is used depends on exactly what we learn during your angiography.

After Your Procedure:

When your angiography is done, a piece of tape will be placed over the cut. Although the incision is very small, the area needs to begin healing before you go home. Consequently, you'll be our guest for the rest of the day, lying flat. Although you'll need to lie still, you'll be able to eat and drink, and visitors are allowed. Expect that you'll be released in the late afternoon. You will not be allowed to drive home yourself, and you shouldn't drive until the next day.

Your Recovery:

Take it easy at first. Although you should be fine to return to desk work the day after your angiography, avoid lifting or straining for at least a week.

If you're uncomfortable, take Tylenol (Acetaminophen).

For the first few days, if you feel that you're about to cough or sneeze, put gentle pressure where the incision was.

During the healing process, if something happens, and you do begin bleeding from your wound, put pressure on it, and call us. If we're not available, be safe, and get to an emergency room.