Peripheral Vascular Disease and Intermittent Claudication

Peripheral vascular disease affects a significant number of patients and ranges in severity from asymptomatic disease that does not affect the individual through mild to moderate disease that interferes with lifestyle through to severe disease that can result in pain at rest or tissue loss.

This entire broad spectrum of disease requires ‘maximal medical therapy’ to address all the risk factors such as smoking, high cholesterol, high blood pressure, diabetes and anti-platelet medication.

Milder forms of intermittent claudication are usually best treated with an exercise programme. The aim of this is both to improve the collateral or alternative blood supply to the leg(s) and also to improve the patient’s overall cardio-respiratory fitness.

More severe forms may require and endovascular approach. A wire can be passed through the narrow arteries and a balloon used to open up the vessel (Angioplasty).

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Trends in Vascular Surgery

  In the most severe cases some form of surgical bypass may need to be considered.

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The Diabetic Foot

The diabetic patient is particularly vulnerable to problems with circulation. In addition to having problems with the circulation, they can also have difficulty with sensation. A numb foot is at risk of damage and great care must be taken to prevent this.

We have a particular interest in the 'at risk' foot, running a Vascular Orthology Clinic at UCHW. This is a multi disciplinary clinic with a consultant vascular surgeon, a consultant in rehabilitation medicine, an orthotist and a consultant tissue viability nurse.

Bespoke footwear plays an important part in the treatments offered, however the use of the patella bearing orthosis or PTBO is the most common approach. This technique was developed by the the multi-disciplinary team, and invloves unloading the foot via the patella tendon. This increases the speed of wound healing.

Patellar tendon bearing orthosis- application as adjunctive treatment in healing lower limb tissue loss. European Journal of Vascular and Endovascular Surgery 1998; 16: 485-488

Diabetic or neuropathic foot, Imray 1998 - Click here to view PDF

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Charcots Foot

This is a complex problem associated with neuropathic feet. The C&W CVU Vascular Orthology clinic specialises in dealing with these difficult conditions. A patella tendon bearing orthosis allows normal mobility to be maintained.

Revisional Amputation Surgery

With a unique multidisciplinary approach including a Regional rehabilitation consultant, we are in position to offer a service that includes review of problematic existing amputations and occasionally we will consider revisional amputation surgery.

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Bone Spur		Painful Neuroma