Peripheral Artery Disease

Peripheral artery disease, or PAD, affects over 8 million Americans.  Many never experience symptoms, however, even without symptoms people with PAD are at a higher risk of heart attack and stroke. Early diagnosis and treatment can reduce these risks and relieve symptoms of PAD.

PAD is the most common type of peripheral vascular disease (PVD), and is characterized by fatty deposits called plaque on the inside walls of arteries. The medical term for this is atherosclerosis, and is also referred to as “hardening of the arteries”. This can cause a restriction in blood flow to the arms, kidneys, stomach, but most commonly the legs and feet.  Lack of circulation to legs and feet can result in pain, numbness, and in severe cases amputation of the foot or leg.  Early diagnosis and treatment is essential to treating PAD.

Our doctors are highly experienced in diagnosing and treating PAD.  The skilled interventional team specializes in several minimally invasive outpatient procedures that reduce blockages in arteries allowing you to return to an active life. Angioplasty is used to open up blood vessels that are narrowed by plaque to flow more freely and easily to the feet.  Our patients benefit from stent placements, in which a small mesh tube is placed to hold the blood vessel open for enhanced circulation. If blood clots are found, thrombectomy or thrombolysis is used to dissolve or remove the blood clot before it causes further damage. These minimally invasive outpatient treatments have saved patients from amputation and given them an enhanced quality of life.

PAD causes a restriction in blood flow to the legs and feet due to plaque buildup in the arteries. When you exercise, your muscles needs more oxygen, and thus they need more blood flow. If the muscles are not provided with the oxygen they need, they can cramp or feel achy or tired. The symptoms of PAD may appear only when you exercise, and subside shortly after you stop. This is called “intermittent claudication”, and it is the most common symptom of PAD.

SYMPTOMS

• Pain in legs or buttocks
• Cramping in legs or buttocks
• Fatigue in legs or buttocks
• Numbness in legs
• Numbness in feet
• Symptoms subside a few minutes after you stop exercising

SIGNS

• Legs or feet cooler than other parts of your body
• Non-healing sores on the foot or leg
• Gangrene in sores on your foot or leg
• Low blood pressure in legs and feet

Symptoms are indicators of a disease that you experience, while signs are indicators of a disease that can be seen. Your doctor will ask you about the symptoms you experience and examine you for signs.

PAD can be diagnosed by a physical exam coupled with several painless non-invasive tests. An ankle-brachial index (ABI) test will be performed to check the blood pressure at your ankle. In an adult without PAD, this should show an ankle pressure that is at least 90% of the blood pressure taken on the arm. In an adult with PAD, it may be as little as 50%.

If the ABI test indicates a possible narrowing of the arteries, your doctor may perform one of the following tests to gather more information:

• Doppler and Ultrasound (Duplex) imaging: a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
• Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs.
• Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without using X-rays.
• Angiography: the examination of the arteries by using a contrast agent and X-rays to look for blockages in the arteries of the leg. This is generally done during treatment to view the blood flow so it is clear when the blockage has been removed.

PAD is the leading cause of amputation of the legs or feet. Lack of blood flow to the legs and feet can result in poor healing, so even a small wound can eventually become gangrenous and eventually require amputation.

When the arteries of the extremities have plaque buildup, it is likely a sign that other blood vessels in the body are experiencing the same problem. Coronary artery disease is plaque buildup in the blood vessels to the heart; carotid artery disease is plaque buildup in the blood vessels to the brain. Coronary artery disease causes heart attacks, and carotid artery disease causes strokes. People who have PAD are six or seven times more likely to experience a heart attack or stroke.

If you are experiencing any symptoms of PAD, you should see your doctor immediately.

PAD is a serious disease with dangerous risks if it is left untreated. The first step is to treat the symptoms, such as leg pain, so that you can maintain an exercise program. Exercising

Many cases of PAD can be treated by lifestyle changes, including dietary changes and exercise changes. Appropriate food and exercise can actually reduce the plaque buildup.

Lifestyle Changes

It is important for your overall health to change your lifestyle to reduce your risks from PAD. You should reach and maintain a healthy weight and eat food low in saturated fat, trans fat, and cholesterol. If you have diabetes, you should be working with a doctor to be sure that it is properly controlled. If you smoke, you should quit. Smokers are typically diagnosed with PAD 10 years earlier than people who do not smoke.

Medication

Medication may be necessary to reduce or control your risk factors for PAD, including high cholesterol, high blood pressure, or diabetes. In addition, your doctor may prescribe a medication to prevent blood clots. PAD causes blood to move sluggishly which encourages clot formation. There are also medications available that relieve the pain of PAD and may make it more comfortable for you to begin and maintain an exercise program.

Medical Intervention

It will take time for lifestyle changes and medication to provide relief from PAD symptoms and reduce the risk of heart attack and stroke. For a minority of people with PAD, lifestyle and diet changes may not reduce plaque buildup sufficiently. In these cases, your doctor may feel that a medical procedure is necessary.

MINIMALLY INVASIVE PROCEDURES

Our doctors can perform several minimally invasive procedures to treat PAD. These procedures are done in our outpatient facility, so you won’t need a hospital stay.

• Angioplasty: Angioplasty is a procedure in which a tiny balloon is placed into your blood vessel and then expanded to compress the plaque and leave more room for the blood to flow. Sometimes a cylindrical wire mesh tube, called a stent, is placed in the artery to hold the vessel open.
• Thrombolysis or Thrombectomy: If you have a blood clot that is blocking an artery and causing PAD symptoms, our doctors can guide a tiny catheter through your artery to reach the clot, then inject it with a clot-busting (thrombolytic) agent so that it dissolves harmlessly and leave the artery clear. The could also perform a thrombectomy to remove the clot.

SURGICAL BYPASS

If angioplasty is not appropriate for your situation, you may require bypass surgery. Bypass surgery involves using a manufactured or transplanted healthy artery and replacing the blocked or narrowed artery. The blood can then bypass the unusable artery. This is a involved procedure, and will require a hospital stay.

There are some risk factors for PAD that you cannot control, such as heredity, diabetes, or aging. There are others that you can control, such as lack of exercise, smoking, and consuming high fat foods. If you have high blood pressure or high cholesterol, you should be working with a doctor to control those factors.

• Smoking
• Consuming high fat foods
• Lack of exercise
• Diabetes
• High blood pressure
• High cholesterol
• Obesity
• Heredity
• Age – over 50

Most people with PAD have no symptoms. The first symptom may be a heart attack or stroke. If you have any of these risk factors, talk to your doctor about a screening for PAD. It can be detected even if it isn’t causing you any pain or disability. If you know that you have PAD, you can take steps to improve your lifestyle and reduce the chances of serious complications.