Peripheral Artery Disease (PAD)

What is PAD?

Peripheral Arterial Disease (PAD) is poor circulation of blood to your legs. It is caused by atherosclerosis, a buildup of fat and cholesterol deposits in the arteries that supply blood to the extremities. This results in ischemia or inadequate blood supply to these tissues. Patients suffer from cramping, aching, pain, numbness or heaviness in the leg muscles when walking or climbing stairs. Unfortunately, many people think the symptoms of PAD are due to something else, so it often goes undiagnosed.

What causes PAD?

PAD is caused by the narrowing of the arteries outside of your heart. People with diabetes, high blood cholesterol, high blood pressure, smoking, heart disease and stroke are at increased risk of developing PAD.

What are the symptoms of PAD?

All the symptoms are related to a lack of blood flow in the affected areas.

  • Intermittent Claudication- this is pain or discomfort in the affected muscles that gets worse when exercising or even walking, and is relieved by rest, due to lack of blood flow. When exercising your muscles need extra oxygen to function. When the arteries are blocked the muscles don’t get the needed oxygen. This causes difficulty walking or climbing stairs, and cramping in the affected legs, buttocks, thighs, calves, and feet.
  • Weak or absent pulses in the ankles, legs or feet
  • Sores on the toes, feet or legs that heal slowly or not at all
  • Cooler skin temperature on the affected areas
  • Poor nail growth on toes and lost hair on legs
  • Erectile dysfunction

What are the added risks from PAD?

  • If severe, blocked blood flow can cause tissue death and non-healing ulcers on the ankles and legs.
  • Increased risk of heart attack or stroke and transient ischemic attacks or mini-strokes. PAD and Cardiovascular artery disease have the same causes.
  • Untreated PAD can cause gangrene and result in amputation of the affect limbs.

How is it diagnosed?

Diagnosis is based on your medical and family history, a physical exam, imaging and blood tests.

Diagnostic tests may include:

  • Ankle-Brachial Index- a simple test that compares blood pressure in you ankle to blood pressure in your arm. It shows how well your blood is flowing in your limbs.
  • Doppler Ultrasound- a handheld device is passed over your body including the affected areas. A computer converts sound waves into a picture of blood flow. This test can show a blocked blood vessel.
  • Angiogram – during this test, dye is injected into your arteries. Then an x-ray is taken. The dye shows the location of the blockage, the extent of blockage and the type of blockage.
  • Blood tests- may be given to check PAD risk factors, such as a test for diabetes or high cholesterol.

What are the treatments for PAD?

  • Increasing physical activity
  • Quitting smoking
  • Lowering blood pressure
  • Lowering high cholesterol
  • Lowering blood sugar levels

Narrowing of a large artery happens gradually. So if you can improve your behavior you will reduce the risk of serious complications and advanced disease. If your disease is already well advanced, the surgical and medical procedures below can help open the artery to improve blood flow.

Medications

There are medications that can help improve symptoms. They may be used by people who have failed other treatments or are too sick to undergo even minimally invasive procedures.

Surgical and Medical Procedures

  • Minimally Invasive Angioplasty. During this procedure, the surgeon will insert a catheter with a balloon at the tip, into the femoral artery in the groin. The balloon is threaded through the artery until it reaches the blockage. Then it is inflated. This opens the vessel and allows blood to flow more freely. The balloon is removed and a stent may be put in place to keep the artery open after the procedure is done.
  • Laser Atherectomy. This non-invasive procedure uses a small fiber optic catheter connected to a laser. The catheter is threaded through a large vessel in the groin to the diseased artery. Your surgeon will use the laser heat to break up the blockage to increase blood flow.
  • Bypass grafting. If blood flow is blocked, your surgeon can take a vessel from another part of your body and replace the diseased artery with this graft. The best candidates are under age 70, who do not have diabetes. Patients with diabetes or over the age of 70 face a higher risk for post-operative complications.