Peripheral Arterial Disease
Peripheral Arterial Disease, often called PAD, occurs due to plaque accumulation in arteries carrying oxygenated, nutrient rich blood from your heart to your organs and extremities. Plaque is an accumulation of fat, cholesterol, calcium and other substances in the blood. Over time, plaque accumulations, thicken, harden and narrow your arteries obstructing the flow of oxygenated blood. This accumulation of arterial plaque is called Arteriosclerosis or Atherosclerosis.
Peripheral Arterial Disease most often occurs in the leg arteries, but can also occur in the arteries that carry blood from your heart to your brain, arms, kidneys, and intestines. One in every 20 Americans over the age of 50 has peripheral arterial disease, a condition that raises the risk for heart attack and stroke. Our team focuses on the diagnosis and treatment of the arteries in your legs.
If you have leg pain when you walk or climb stairs that continues over an extended period of time, it might be a symptom of PAD. Sometimes, this symptom is dismissed as part of aging; this is not necessarily so, the cause of the pain could be PAD. If you have been experiencing leg pain, tell your doctor and discuss whether you should be tested for PAD.
Blocked blood flow to your legs can cause discomfort, pain and numbness. In severe cases it can raise your risk of infection in the affected limb. In severe cases, blocked blood flow can cause gangrene (tissue death) and lead to leg amputation if not treated promptly.
Symptoms include the following:
- Pain while walking that is relieved by rest, this is called Intermittent Claudication
- Non-healing wound or ulcer
- Skin discoloration
- Leg numbness or weakness
- Coldness in your lower leg or foot, especially when compared to the other leg
- Painful cramping that can happen from your hips all the way to your feet that worsen with walking
- Slower growth of toenails and hair on the legs
- Erectile dysfunction in men
Causes & Risk Factors
Include the following:
- Atherosclerosis (fatty deposit build up in the arteries)
- High blood pressure
- High cholesterol
- Older age, especially over 50 years
- High homocesteine levels
Diagnosis & Treatment
Physical Exam: Your doctor may find signs of peripheral arterial disease during a physical examination such as a weak or absent pulse in your legs and feet, discoloration of your legs, difference in temperature of each of your legs, and by listening to your arteries with a stethoscope and discovering a bruit.
Ultrasound: Doppler ultrasound technique can help your doctor evaluate blood flow in the arteries and can reveal blocked or narrowed arteries.
Ankle-brachial Index (ABI): This test compares the blood pressures in your arms to the blood pressures in your legs by using regular blood pressure cuffs. Lower blood pressures in the legs compared to the arms indicates that there is blockage in the arteries in your legs.
Angiography: This minimally invasive procedure uses a catheter that is placed in an artery through your groin area and then contrast media (dye) is injected through the catheter. With the aid of fluoroscopy, (live x-ray) your doctor is able to trace the contrast through the arteries and identify any blockages or narrowing.
Angioplasty and Stenting: Angioplasty is the surgical widening of a narrowed artery with an inflatable balloon catheter. While it is often done as a sole procedure, depending on each patient, angioplasty may be followed with stenting. Stenting is a procedure in which a small metal mesh is inserted through a catheter into the affected artery to maintain it permanently widened.
This procedure usually takes between 1 to 2 hours to complete. Before the procedure begins, a nurse will begin an intravenous line in your arm to be able to administer medication and fluids throughout the procedure. The procedure is done under light sedation, meaning you will be awake, but will be given medication to help you relax and may make you sleep throughout the procedure.
The skin where the catheters (thin, flexible tubes) are inserted will be numbed with medication. A catheter with a small balloon tip is inserted into the artery to widen the passageway. The doctor is able to properly guide the catheter with fluoroscopy imaging on a monitor. Then a thin guide wire is passed through the catheter into the artery. Next, a balloon tipped catheter is inserted into the artery, threaded over the guide wire and moved to the spot where the artery begins to narrow.
Once placement is ensured, the balloon is inflated and deflated multiple times to break the plaque up and press it against the artery wall. This will cause the artery to expand and improve blood flow. Once the balloon is deflated and removed, a stent, a small metal mesh frame, may be inserted inside the artery to maintain the walls open.
Atherectomy: Atherectomy is a procedure used to remove the cholesterol and fibrous tissue blocking arteries. Most atherectomy procedures are performed in the legs to treat symptoms of a peripheral vascular disease (PVD). Through a tiny incision, a catheter (long, soft plastic tube) is inserted into the blood vessels and guided to the area of blockage. Attached to the catheter is a device that cuts and shaves the plaque and tissue blocking the blood vessel. The procedure is often used as the first treatment and sometimes to widen arteries that have closed or become blocked again following a balloon angioplasty and treatment with stents.