What is peripheral arterial (or vascular) disease (PAD)?

Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a common condition affecting over 30 percent of Americans by the age of 65.  This disease of the blood vessels which carry oxygen to the legs develops when cholesterol and plaque form in the walls of the arteries.  As the walls become thicker, the vessel becomes smaller, decreasing blood flow to the legs.   

People who suffer from PAD are likely to have blocked arteries in other areas of the body.  They are increased risk for heart disease, heart attacks, abdominal aortic aneurysms

("triple A"), sexual dysfunction, and strokes.  Patients with diabetes, high cholesterol, and high blood pressure, and who use tobacco are at a higher risk for PAD.

How would I feel if I had peripheral arterial disease?

The most common symptom of PAD is painful cramping in the leg or hip that occurs when walking or exercising, called "intermittent claudication."  The cramping typically stops when you stop and rest.  Also, you may notice numbness, burning, a cold sensation, tingling and weakness in your legs and feet.  The symptoms can vary widely! Other symptoms include:

• Burning or aching pain in your feet or toes even at rest
  
• A sore or ulcer on your leg or foot that won’t heal
  
• Always feeling cold in your legs and/ or feet
  
• Color changes in the skin of your legs and/ or feet
  
• Loss of hair on legs
  
• Waking up at night with painful legs and/ or feet

Many people don't realize there is a serious problem with their circulation and do not seek help until there is permanent damage.  

REMEMBER:  It's not a normal part of aging to have these symptoms!

What makes me at risk for peripheral arterial disease?

• Male
  
• Over the age of 50
  
• Tobacco use
  
• Diabetes
  
• Overweight
  
• Very little physical activity
  
• High blood pressure, high cholesterol, or high lipid blood test
  
• Family history of vascular disease, such as PAD, aneurysm, heart attack or stroke

How do we test for peripheral arterial disease?

The most common test for PAD is the ankle-brachial index (ABI), a painless exam in which ultrasound is used to measure the ratio of blood pressure in the feet and arms.  If the blood pressure is lower in your legs, there may be a partial blockage of the blood vessels slowing down forward blood flow.  A person with an ABI of 0.3 (high risk) has twice the risk of a heart attack death within five years compared to a patient a normal ABI (0.9-1).  Once we find a difference in blood pressures, we may order additional studies including an ultrasound, CT, or MRI exam.  In other cases, we will proceed directly with a catheterization of your blocked vessels with a procedure called angiography where we can immediately fix it.

Is there any way to "fix" peripheral artery disease?

Lifestyle Changes
First thing is first.  There are many bad habits which contribute to PAD such as tobacco use, poor diet, and lack of exercise.  By changing these factors, you can slow the problem from getting worse and actually reduce your overall symptoms.

Medication
Unfortunately, most medications only slightly reduce the symptoms of claudication.  They cannot remove the blockage but can help from making it worse (such as cholesterol or blood pressure medications).  Also, they can slightly improve the oxygen flow in blood to your legs.

What treatments are performed at the Interventional & Vascular Center?

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Angioplasty and stenting

​Interventional radiologists first invented angioplasty and stenting several decades ago.  The technique was first used to open blood vessels in the leg and eventually used to open ones in the heart ("coronary angioplasty").  Using ultrasound and x-ray imaging guidance, our physician will thread a tiny tube (called a "catheter") through the artery in your groin, to the blocked artery in the legs.  A balloon will be inflated to open the blood vessel where it is narrowed or blocked.  Sometimes, this is held open with a stent, a small metal cylinder.  This is a minimally invasive treatment that does not require surgery or overnight stay in the hospital.  It simply involves a nick in the skin and your willingness to improve your life! 

Balloon angioplasty and stenting have generally replaced invasive surgery as the first-line treatment for PAD.  Many randomized trials have shown interventional therapy to be as effective as surgery for many arterial occlusions, and with longer lasting results.  This is now the first-line treatment of many of these blockages.

Stent-grafts
A stent covered with fabric can also be inserted into the blocked blood vessel to keep it open.  These are often used when there is significant damage to the blood vessel wall that a normal stent will not keep the vessel completely open.

Atherectomy
Rather than just using a ballon or stent, atherectomy involves advancing a special device into the artery at the site of blockage.  The device can actually remove the plaque on the vessel wall, opening the vessel back to a normal size.  Sometimes, we don't even need to place a metal stent into the vessel after the plaque removing procedure.

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Surgery
Sometimes, open surgery is required to remove blockages from arteries or to bypass the clogged area.  But we at the Interventional & Vascular Center believe this should be the last option, as it is most invasive and requires the longest recovery time.