Peripheral Artery Disease
What is Peripheral Arterial Disease (PAD)?
Peripheral arterial disease (PAD) is narrowing or blockage of arteries that results in poor blood flow to the arms and legs. When you walk or exercise your leg muscles don’t get enough blood and you can get painful cramps, which tend to subside when stopping the activity.
Peripheral arterial disease, also known as peripheral vascular disease, occurs most commonly in the legs.
What causes PAD?
The most common cause is the buildup of plaque on the inside walls of arteries, resulting in narrowing or blockage of those vessels. Plaque is made of extra cholesterol, calcium and other material in the blood. Over time, plaque builds up in the walls of the arteries, including those that supply blood to your legs. High cholesterol, high blood pressure, and smoking all contribute to plaque buildup.
As plaque builds up in the arteries, there is less room for blood to flow, preventing oxygen-rich blood from being delivered to the leg muscles. Without adequate oxygen, the muscles ache and cramp. In severe cases, pain can occur at rest.
What are the symptoms of PAD?
Many people who have PAD don’t have any symptoms because plaque build up has not become significant to cause decreased blood flow.
Factors that increase the risk of developing PAD include:
- High cholesterol
- High blood pressure
- Obesity (a body mass index over 30)
- Increasing age, especially after 50 years of age
- A family history of PAD, heart disease or stroke
Smokers and diabetics are at highest risk of developing PAD. Patients with these risk factors should have simple vascular screening to detect and prevent further plaque buildup.
Classic symptoms include a tight, aching or squeezing pain in the calf, thigh, or buttock after walking, running or exercising. The pain often subsides after stopping the activity and resting. This pain is referred to as intermittent claudication which usually happens after a person has walked a certain distance. For example, a patient’s pain may always start after walking a few blocks or after a few minutes. The pain goes away with stopping and resting. As PAD gets worse, meaning the narrowing or blockage increases, pain may occur in the feet or toes without activity called rest pain. This is a severe form of PAD, and needs to be evaluated by a vascular specialist.
Other symptoms may include:
- Leg numbness or weakness
- Coldness or change in color in the lower leg or foot
- No pulse or a weak pulse in your legs or feet
- Sores on toes, feet or legs that are slow to heal
- Hair loss over the legs or slow growth of toenails
- Erectile dysfunction in men
How is PAD diagnosed?
At DVVI, a full history and physical exam will be performed including a vascular health screening called an Ankle-Brachial Index or ABI. This non-invasive vascular exam will help predict the severity of disease. During the vascular exam, the pulses at the groin, behind the knee, and on the ankle and foot are palpated. The strength or weakness of a pulse determines the strength of blood flow. An absent or weak pulse indicates presence of PAD. Based on the initial evaluation, further testing may be ordered including arterial Doppler ultrasound, a non-invasive, highly specialized exam, designed to detect accurately areas of narrowing or blockage. Other diagnostic studies which may be ordered are computer tomography angiogram (CTA), magnetic resonance angiogram (MRA) or a diagnostic angiogram.
How is PAD treated?
At DVVI, we take a comprehensive approach to treatment of PAD which can range from an exercise and diet program to medical management and optimization of medications to endovascular repair such as angioplasty or atherectomy.
Treatment for peripheral artery disease has two major goals:
- Manage symptoms, such as leg pain, so that physical activities can be resumed.
- Stop the progression of atherosclerosis throughout the body to reduce the risk of heart attack and stroke.
- Smoking cessation.
- Healthy, balanced diet.
- Maintain a healthy weight
- Exercise or walking program.
- Control high blood pressure and diabetes
- Manage high cholesterol
If lifestyle changes fail to relieve symptoms, medical management may include certain medications to improve circulation, slow down plaque formation, manage cholesterol or control blood pressure.
- High blood pressure medications. The goal of this therapy is to reduce the systolic blood pressure to 140 millimeters of mercury (mm Hg) or lower and the diastolic blood pressure to 90 mm Hg or lower.
- Medication to control blood sugar. With diabetes, optimizing blood sugar levels is important to prevent progression of PAD.
- Cholesterol-lowering medications. Called a statin, helps to reduce risk of heart attack and stroke.
- Medications to prevent blood clots. Daily aspirin therapy or another antiplatelet medication, such as clopidogrel (Plavix), may be prescribed if there is high risk of blood clot, heart disease or carotid disease.
- Symptom-relief medications. Certain drugs which increase blood flow to the legs may help treat symptoms of claudication, such as leg pain.
In more severe cases, endovascular repair may be indicated. In some situations when endovascular repair is not feasible, bypass surgery may be necessary.
At Desert Endovascular Surgical Center, we offer cutting-edge technology to safely and effectively restore blood flow to the legs. We use a combination of various endovascular techniques including angioplasty, stent placement and atherectomy (de-bulking and removal of plaque) to restore blood flow.