Circulatory Disorders (Peripheral Vascular Disease)

Circulatory disorders are diseases of the arteries, veins and lymph vessels outside the heart. The main ones are peripheral arterial disease, where fatty plaque narrows the leg arteries; chronic venous disease, including varicose veins and venous ulcers; deep vein thrombosis; aneurysms; Raynaud's phenomenon; and lymphoedema.

Arterial and venous problems are often confused but behave differently and need opposite advice on some points, such as compression. Peripheral arterial disease also signals a raised risk of heart attack and stroke, so treatment is about protecting the whole circulation and not only the legs.

Symptoms

• Cramping calf, thigh or buttock pain on walking that eases within minutes of stopping
• Cold, pale or bluish feet, loss of leg hair, slow-growing toenails
• Foot pain at night relieved by hanging the leg out of bed
• Sores on toes, heel or ankle that do not heal
• Aching, heavy, swollen legs with visible varicose veins, worse by evening
• Brown discolouration or eczema around the ankle
• One-sided calf swelling, warmth and tenderness
• Fingers turning white then blue then red in the cold

Causes and risk factors

Arterial disease is driven by atherosclerosis. Smoking is the strongest risk factor, followed by diabetes, high blood pressure, high cholesterol, kidney disease and age. Venous disease arises when valves in the leg veins fail, allowing blood to pool; heredity, pregnancy, obesity, prolonged standing and previous clots contribute. Deep vein thrombosis follows immobility, surgery, long journeys, cancer, oestrogen-containing medicines and inherited clotting tendencies. Raynaud's may occur alone or with connective tissue disease. Lymphoedema follows cancer surgery, radiotherapy or infection, or is inborn.

How it is diagnosed

• Pulse examination and ankle-brachial index: Comparing ankle and arm pressures is a quick, reliable screen for arterial disease. Toe pressures are used in diabetes.
• Duplex ultrasound: Maps narrowings in arteries, reflux in veins and clots, without radiation.
• CT or MR angiography: Plans angioplasty or bypass by showing the whole arterial tree.
• Blood tests: Glucose, lipids, kidney function, and D-dimer when a clot is suspected.
• Catheter angiography: Performed at the time of treatment.

Treatment options

• Risk factor control: Stopping smoking, a statin, an antiplatelet drug, and blood pressure and diabetes control. This prolongs life.
• Supervised exercise: Walking programmes roughly double pain-free walking distance in claudication.
• Angioplasty, stenting and atherectomy: Catheter treatments for limiting claudication or threatened limbs.
• Bypass or endarterectomy: Surgery for long blockages or when catheter methods fail.
• Compression stockings: Mainstay for venous disease and ulcers, once arterial supply is confirmed adequate.
• Endovenous ablation and sclerotherapy: Laser, radiofrequency, glue or foam to close faulty veins under local anaesthetic.
• Anticoagulation: For deep vein thrombosis, usually at least 3 months.
• Wound and foot care: Specialist dressings, offloading and podiatry, vital in diabetes.

When it is urgent

Call emergency services locally if a leg suddenly becomes painful, pale, cold, numb or weak, which suggests a blocked artery that must be reopened within hours. The same applies to sudden breathlessness or chest pain with a swollen calf, spreading infection or black tissue on the foot, and sudden severe abdominal or back pain in someone with a known aneurysm.

Travelling to Türkiye for treatment

Planned treatment suits a visit: varicose vein ablation needs 3 to 5 days, and elective leg angioplasty or a work-up with duplex and CT angiography about 5 to 7 days. Non-healing ulcers, diabetic foot problems and new clots need continuous local care, and long flights with an untreated clot or critical limb ischaemia are unsafe. After any vascular procedure, ask about stockings, walking and blood thinners for the flight home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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