What is peripheral arterial disease (PAD)?
PAD is also known as “hardening of the arteries”. Healthy arteries are smooth on the inside but, as you age, they can become blocked through a process called atherosclerosis, which means hardening of the arteries. A sticky substance called plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, your arteries narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow to your leg arteries. When this happens, your leg does not receive the oxygen it needs.
PAD can cause discomfort or pain when you walk. The pain can occur in your hips, buttocks, thighs, knees, shins, or upper feet. Leg artery disease is considered a type of peripheral arterial. You are more likely to develop PAD as you age. One in 3 people age 70 or older has PAD. Smoking and diabetes increase your chances of developing PAD.
What are the symptoms of PAD?
Claudication: You may not feel any symptoms from peripheral artery disease at first. The most common early symptom is intermittent claudication (IC). IC is discomfort or pain in your legs that happens when you walk and goes away when you rest. You may not always feel pain; instead you may feel a tightness, heaviness, cramping, or weakness in your leg with activity. IC often occurs more quickly if you walk uphill or up a flight of stairs. Over time, you may begin to feel IC at shorter walking distances. Only about 50 percent of the people with leg artery disease have blockages severe enough to experience IC.
Critical limb ischemia is a symptom that you may experience if you have advanced peripheral artery disease. This occurs when your legs do not get enough oxygen even when you are resting. With critical limb ischemia, you may experience pain in your feet or in your toes even when you are not walking.
In severe peripheral artery disease, you may develop painful sores on your toes or feet. If the circulation in your leg does not improve, these ulcers can start as dry, gray, or black sores, and eventually become dead tissue (called gangrene).
What causes peripheral artery disease (PAD)?
Atherosclerosis causes peripheral artery disease. As you get older, your risk of developing leg artery disease increases. People older than age 50 have an increased risk of developing the disease, and men have a greater risk than women. Other factors that increase your chances of developing the disease include:
- High blood pressure
- High cholesterol or triglycerides
- Weighing over 30 percent more than your ideal weight
If I have PAD, am I at risk of having other types of vascular disease?
Yes. Athersclerosis (“hardening of the arteries”) is a systemic condition. Patients with PAD are also at risk of having coronary artery disease and carotid artery disease.
What tests will I need?
After your exam, we may order additional tests such as:
- Ankle-brachial index (ABI), which compares the blood pressure in your arms and legs
To better understand the extent of your leg artery disease, we may also recommend duplex ultrasound, pulse volume recording, magnetic resonance angiography (MRA), or angiography.
- Duplex ultrasound uses high-frequency sound waves to measure real-time blood flow and detect blockages or other abnormalities in the structure of your blood vessels
- Pulse volume recording measures the volume of blood at various points in the legs using an arm blood pressure cuff and a Doppler probe
- Magnetic resonance angiography (MRA) uses magnetic fields and radio waves to show blockages inside your arteries
- Computed tomographic angiography (CTA) uses specialized CT scans and contrast dye to show blockages inside your arteries
- Angiography, which produces x ray pictures of the blood vessels in your legs using a contrast dye to highlight your arteries
How is leg artery disease treated?
Unlike Cardiologists and Radiologists, Vascular Surgeons are trained to offer ALL available treatments for peripheral artery disease (PAD)
If your peripheral artery disease is detected early, you can make lifestyle changes to help you manage your disease.
We may also recommend medication to treat conditions that worsen or complicate leg artery disease. These medications may include cholesterol-lowering drugs (statins) or blood pressure-lowering medications. You may also need to take medications that reduce blood clotting to minimize the chances of clots blocking your narrowed arteries.
If you do not have a disqualifying medical condition, such as heart failure, we may also prescribe cilostazol (Pletal), which can improve the distance you are able to walk without discomfort or pain. Other drugs we may prescribe include aspirin and clopidogrel (Plavix), either of which can decrease your chances of developing blood clots.
Exercising and walking regularly, for instance walking at least 30 minutes 3 times each week, may help improve your symptoms.
In more severe cases of leg peripheral disease, lifestyle changes and medication may not be enough to improve your symptoms. Also, if your disease has advanced, we may recommend surgical or minimally invasive treatments. The choice of the treatment depends upon the pattern and extent of the blockages as well as other factors, such as your general health and the presence of other medical conditions. We will help you determine which is the best option for your particular situation. Sometimes a combination of the various tools available may be required for the most favorable results.
Angioplasty and stenting
In some cases of peripheral artery disease, we may recommend angioplasty and stenting. This procedure is considered to be minimally invasive in comparison to open surgery. It is most effective for more localized blockages in the larger arteries. In an angioplasty, we insert a catheter into a small puncture over an artery in your arm or groin. The catheter is guided through your arteries to the blocked area. Once in place, a special balloon, which is attached to the catheter, is inflated and deflated several times. The balloon pushes the plaque in your artery against your artery walls, widening the vessel. In some circumstances, we may then place a tiny mesh-metal tube, called a stent, into the narrowed area of your artery to keep it open. The stent remains permanently in your artery. After this procedure, blood flows more freely through your artery. Other devices, such as atherectomy catheters, may be used to remove plaque build-up inside the arteries.
Bypass surgery creates a detour around a narrowed, or blocked, section of a leg artery. To create this bypass, we may uses one of your veins or a tube made from man-made materials. We attach the bypass above and below the area that is blocked. This creates a new path for your blood to flow to your leg tissues and is particularly effective for extensive artery blockages.
An endarterectomy is a way for your surgeon to remove the plaque from your artery. To perform an endarterectomy, we make an incision in your leg and removes the plaque contained in the inner lining of the diseased artery. This leaves a wide-open artery and restores blood flow through your leg artery. The effectiveness of this method depends upon the particular location and extent of the arterial blockage