Peripheral Arterial Disease

Did You Know?

The most common symptom of PAD is leg pain when walking or during exercise that improves with rest.

Peripheral Arterial Disease

PAD is a common circulation problem in which the arteries that carry blood to the legs or arms become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain, but often causing no symptoms at all. The most common cause of PAD is atherosclerosis, often called “hardening of the arteries.” Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called “plaque” that clogs the blood vessels. In some cases, PAD may be caused by blood clots that lodge in the arteries and restrict blood flow. Left untreated, this insufficient blood flow will lead to limb amputation in some patients.

In atherosclerosis, the blood flow channel narrows from the buildup of plaque, preventing blood from passing through as needed, restricting oxygen and other nutrients from getting to normal tissue. The arteries also become rigid and less elastic, and are less able to react to tissue demands for changes in blood flow. Many of the risk factors-high cholesterol, high blood pressure, smoking and diabetes-may also damage the blood vessel wall, making the blood vessel prone to diffuse plaque deposits.

Causes of Peripheral Arterial Disease

PAD is a disease of the arteries that affects 10 million Americans.
PAD can happen to anyone, regardless of age, but it is most common in men and women over age 50.
PAD affects 12-20 percent of Americans age 65 and older.

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Risk Factors for Developing Peripheral Arterial Disease

Factors that increase your risk of developing peripheral arterial disease include:

Smoking
Diabetes
Obesity (a body mass index over 30)
High blood pressure
High cholesterol
Increasing age, especially after reaching 50 years of age
A family history of peripheral arterial disease, heart disease or stroke

Symptoms

Testing

Imaging

Treatment

Symptoms

What are the symptoms of Peripheral Arterial Disease (PAD)?

The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.

Other symptoms of PAD include: numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don’t heal.

Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.

Testing

How do I get tested for Peripheral Arterial Disease (PAD)?

Get tested for PAD if you:

Are over age 50
Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
Have high cholesterol and/or high lipid blood test
Have diabetes
Have ever smoked or smoke now
Have an inactive lifestyle
Have a personal history of high blood pressure, heart disease, or other vascular disease
Have trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is relieved by resting
Have pain in the legs or feet that awaken you at night

The ABI, a comparative blood pressure reading in the arm and ankle, is used to screen for peripheral arterial disease. It is a direct measure of fatty plaque buildup in leg arteries and an indirect gauge of plaque accumulations throughout the entire cardiovascular system.

Imaging

What imaging tests are used to diagnose Peripheral Arterial Disease (PAD)?

Duplex Ultrasound

This is often done as a first line non-invasive diagnostic test utilizing ultrasound waves. A probe is placed on the skin with gel and areas of narrowing or blockages in your legs, neck, and kidneys can be evaluated.

CTA or MRA

This test uses a CAT scan or an MRI and typically with dye or contrast to give us a “road map” of your blood vessels. This is also a non-invasive test which gives us valuable information for planning treatment and is typically done following abnormalities seen on ultrasound.

Angiography

This is a more invasive test and often is done at the time of treatment. An interventional radiologist performs this X-ray procedure, which is also called an angiogram. During the angiogram, the doctor inserts a thin tube (catheter) into the artery through a small nick in the skin about the size of the tip of a pencil. A substance called a contrast agent (X-ray dye) is injected to make the blood vessels visible on the X-ray.

Treatment

How is Peripheral Arterial Disease (PAD) Treated?

Lifestyle

Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.

Angioplasty and Stenting

In this technique, the interventional radiologist inserts a very small balloon attached to a thin catheter into a blood vessel through a small nick in the skin. The catheter is threaded under X-ray guidance to the site of the blocked artery. The balloon is inflated to open the artery. Sometimes, a small metal scaffold, called a stent, is inserted to keep the blood vessel open.

Balloon angioplasty and stenting have generally replaced open surgery as the first-line treatment because randomized trials have shown interventional therapy to be as effective as surgery for many arterial occlusions. In the past seven to ten years, a very large clinical experience in centers around the world has shown that stenting and angioplasty are preferred as a first-line treatment for more and more processes throughout the body.

Peripheral Arterial Disease

Did You Know?