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Leg artery occlusion -Diabetic foot

Treating vascular disease like leg artery occlusion
and diabetic foot that are caused by circulatory failure to the tip of toe.

Leg artery occlusion -Diabetic foot
Vascular problems that hemodialysis patient must be careful
– Have them treated at MINT hospital.

Leg artery occlusion

The disease that patient who had hemodialysis for long time must be aware of

What is leg artery occlusion?

Leg artery, one of the peripheral arteries, supply blood from the heart to leg. If wastes in the blood narrow or occlude leg artery, blood circulation cannot reach to the end of toes,
and it is called leg artery occlusion (Peripheral arterial occlusive disease, PAOD)
This disease is most common amongst vascular diseases, increases exponentially after 40 and is most prevalent in 60~70s.
Those with risk factors of diabetes, hypertension, hyperlipidemia, smoking, and family history have 3~4 times the risk than general population. Hemodialysis patient vulnerable to vascular disease has higher risk.


Major cause

  • 01

    Atherosclerosis (Most of the causes)

    Fat (cholesterol) accumulates within the blood vessel, making the vascular wall thicker and narrower.
    Major causes are obesity, hyperlipidemia, lack of exercise smoking, hypertension, and drinking, and renal disease facilitates atherosclerosis.
    Once the blood vessel narrows 50% or more due to atherosclerosis, blood flow decreases, and if narrowed more than 70%, symptoms like pain develop.

  • 02

    Vascular calcification

    Hardening of artery due to accumulation of calcium (calcium carbonate). It occurs when phosphate inside blood is not excreted due to dysfunctional kidney.

  • 03

    Diabetic angiopathy

    Diabetes patient have bad circulation to feet and arteries to lower thigh is damaged the most. Once the symptoms deteriorate and wound in toe or feet is not healed, it is called as ‘ diabetic foot’.

Major symptoms

For legs to move, it requires energy, and the energy is created by the oxygen and nutrients supplied by the blood. However, if blood supply is not sufficient due to occlusion in the leg artery, it causes severe pain. If you feel pain while walking, it is most likely that your leg artery is 70% or more narrow than the normal.



  • Early stage

    Prickle or spasm (claudication) develops in the leg when walking or running, but it eases down after rest.

  • Intermediate stage

    Even walking is difficult as it hurts like leg is about to burst out even after walking short distance of 50 meter.
    If it becomes more severe, the pain does not go away while resting and makes you awake during the night.

  • End stage

    Skin becomes cold and toe turns black. Pulse is weak at the feet and feet wounds do not heal well


!MINT’NOTE

How are the symptoms different from disc herniation?


  • Character of the pain is similar, but its manifestation is different.
    In [leg artery occlusion], it is okay when sitting or lying down. But once the patient starts to walk, the pain arises.
    Also, the time it takes for the pain to develop is consistent. For example, walking 100m causes pain, but after some rest, it gets better. When walking 100m again, the pain arises again, repeating the process Therefore it is important to differentiate the pain when walking and when not walking.
  • Otherwise, the symptoms aggravate more in cold winter than hot days.
    This is because blood vessels shrink and blood flow decreases at low temperature.
    [Disc herniation] has frequent pain and pulling sensation regardless of body position.
    You may not know when the symptom will occur. Pain may arise when you walk for 1 km yesterday, but today you may feel the pain again when you just wake up from sleep.

Diagnosis of leg artery occlusion

  • Ankle-Brachial Index(ABI)

    It is the most convenient and fastest way to check leg artery occlusion. It simply checks blood pressure in each arm and ankle and calculate their difference. It costs a little also. Periodic check is great for preventing leg artery occlusion.

    • ABI

      (Ankle-Brachial Index)
    • =
    • Ankle systolic pressure (maximum pressure) Brachial systolic pressure (maximum pressure)
    Brachial and ankle blood pressure is almost same or ankle pressure is slightly higher in normal person. (Normal range of ABI: 1~1.29). However, if ankle blood pressure is 10% or more lower than brachial blood pressure (ABI ≤ 0.9), there is good possibility of leg artery occlusion.

  • Angiography

    It is the most precise test performed to study which artery is occluded to what degree at where by what. Accuracy of the test is high, but it has complex process and takes long as it requires slight invasive measures to insert and draw out catheter or inject contrast. Therefore, when stenosis is found in basic ultrasound, it is recommended to have angiography along with recanalization.

  • Doppler’s ultrasound

    It can precisely present internal of leg artery, find narrowed section, and identify any thrombus. Also, it is a basic test that can examine vascular abnormality and blood flow.

  • MRA (vascular MRI)

    Unlike conventional vascular CT, it can identify any vascular stenosis or blood flow without using any radiation or contrast that can stress your body.

Treatment
of leg artery occlusion·diabetic foot

Reviving leg artery with minimal invasive arterial recanalization.

It is procedure to insert a small cannula (catheter) of 1~2mm via a small opening made at vein with a needle,
rather than exposing blood vessels by making incision on skin like surgery.



Actual case

Arterial recanalization at leg artery below knee

  • ① All sural arteries are disconnected and thin bypass arteries are slightly visible.
  • ②③ After inserting a balloon catheter and guide wire into the vessel, balloon is inflated to recanalize the obstruction.
  • ④ After recanalization, the blood flow gets better, distinctively showing two arteries that flows from knee to foot.

Diabetic foot

The whole process of feet being damaged as neuropathy
and peripheral vascular disease arises due to diabetes.

What is diabetic foot?

Diabetic foot signifies the whole process when wound at the feet of a diabetic patient does not heal well and continues to be damaged due to complex causes like vascular damage and nerve damage. The other name of diabetic foot is ‘Diabetic foot pathology’


  • ① Adequate blood flow (500mL per minute)
  • ② Adequate fistula diameter (5~6mm or larger)
  • ③ Adequate depth that can be punctured with dialysis needle (5~6mm underneath skin)

Statistically, if a diabetic patient gets injured in the feet, 15% (global average) will occasionally have leg amputation.




  • Leg amputation in diabetic patient
    who is receiving hemodialysis

    • ▲ Thigh
    • ▲ Calf

    The artery in thigh is narrowed and convoluted and the arteries in calf are disconnected. In such condition, if a foot is wounded, blood is not sufficiently supplied to heal the wound, which leads to inflammation and worse condition.

  • vs

  • Normal leg artery

    • ▲ Thigh
    • ▲ Calf

    The arteries are straight to the peripheral arteries. You can see that bloods are flowing continuously.

Major symptoms

In 5 years, 30% of all the patients receive leg amputation surgery. It must be diagnosed at early stage and be treated.



  • Early stage

    When walking too long, the legs become numb and feet feel cold.

  • Intermediate stage

    The legs hurt even when taking a rest and the wound at feet does not heal well.

  • End stage

    Inflammation in the legs start to necrotize. Risk of cardiovascular and cerebrovascular disease increases.

Diagnosis of diabetic foot

  • Ankle blood pressure test

    if ankle blood pressure is 10% or more lower than brachial blood pressure, it signifies narrowing in leg artery.

  • Ultrasound

    It is the most basic test that can examine vascular wall, internal of blood vessel, blood circulation speed and direction.

  • Angiography

    It is the most detailed test that can examine condition of blood vessel in real time with injection of contrast. It can treat and diagnose at the same time.

Two Keypoints for ‘no-amputation’
treatment for diabetic foot

Therapeutic effect of arterial recanalization in diabetic foot


  • Therapeutic effect of arterial recanalization in diabetic foot

  • Recovery without amputation with arterial recanalization and aggressive wound treatment.



  • 1
    Fast, delicate wound treatment
    Your feet must be checked carefully all the time and even a little wound must be disinfected and treated thoroughly. Also, you must improve any lifestyle that may stress your feet (tight shoes, vigorous exercise, untreated athlete’s foot, smoking, etc.)
  • 2
    Precise diagnosis and arterial recanalization
    From time to time, you must check if there is any sign (leg numbness, cold sensation) of local ischemia (insufficient blood flow) due to occlusion of leg artery. In case a problem arises, blood flow small arteries are to be recanalized with recanalization to improve blood flow to the toe or wound in the foot, which can put an end to a malicious cycle that starts from toe then ends at leg amputation.

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  • Weekdays
    AM 8:30 - PM 5:30
  • Saturday
    AM 9:00 - PM 1:00
    service without lunch time
  • lunch time
    PM 12:30 - PM 1:30

Closed on Sunday & National Holidays.
Opening hours can vary for each medical staff, so please confirm before visiting our hospital

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