Peripheral Arterial Disease PAD

Overview

Peripheral Arterial Disease (PAD) is a chronic disease in which plaque builds up in the arteries to the legs. This buildup typically occurs gradually. If allowed to progress, blood flow in that artery can become limited or blocked all together.

PAD is relatively common, affecting more than 10 million people in the U.S. It is more common in people who are 65 or older, but can occur at nearly any age.

Smoking, high blood pressure, high cholesterol or triglycerides, diabetes, kidney failure and obesity increase your risk for PAD.

How would you know if you have PAD?

Many patients experience no symptoms because over time they slowly decrease their activity to avoid symptoms of PAD (pain with walking).

Fatigue or cramping of your muscles (claudication) in the calf, thigh, hip, or buttock may signal you have PADS. Typically the discomfort is felt after walking a certain distance and goes away with rest.  If you have pain in your toes or feet while resting, you may have an advancing case of PAD.  The most advanced stage of PAD is an open wound or ulcer on your toes or feet, often at a pressure point on the foot. An ulcer can progress to gangrene. These symptoms require immediate medical attention.

What causes PAD?

The causes of PAD include smoking, high cholesterol or high triglycerides, high blood pressure, diabetes, kidney failure, and obesity. Genetic factors also play a role, but are not well understood. Of all of these risk factors smoking is the most critical.

Testing for PAD?

You will be asked questions about symptoms and medical history, including questions about family members. The vascular surgeon will also perform a physical exam. 

Tests that may be recommended:

• An initial diagnostic test for PAD is the ankle brachial index (ABI). The test involves taking a blood pressure reading at the ankle and comparing it to that in the arm. 
• Typically an angiogram is done to determine where the in the arteries plaque has built up to assess treatment options. This can be done using a CT or MRI, or possibly by doing a catheter-directed angiogram, which involves placing a thin tube into the artery and injecting dye into the arteries to see where the blockages are located.

Managing PAD

The first phase for treating early PAD is medical care. Risk factors should be aggressively treated - especially smoking cessation. A regular walking program will also provide tremendous benefit. Controlling your blood pressure, cholesterol and diabetes will also help control the disease. 80-90% of patients that reliably follow a conservative plan of care will avoid a surgery or percutaneous intervention.

If your symptoms progress despite these efforts, there are medications to treat the disease. Pletal and Trental are oral medications that help the blood circulate through damaged and diseased arteries. They become effective over a 6-8 week period when patients can see improvement in their walking distance.

If PAD is causing serious symptoms, further treatments such as balloon angioplasty, stent placement, or surgical bypass can be very effective in improving the blood flow to the affected leg.

• Technology has improved that many blocked arteries can be opened with a balloon +/- a stent. These therapies are delivered without making an incision- endovascular therapy-  the artery is accessed percutaneously, and the repair work is done thru an arterial sheath. Once the artery is fixed the sheath and balloon catheter are removed. This minimally invasive therapy can be performed on an outpatient basis.
• Surgical bypass is still part of our treatment strategy. In this instance, disease arteries are replaced by new arteries which route the blood around the old diseased artery. The new artery can be created from the patients own veins (autogenous)or be an artificial artery (non autogenous) made from Goretex or Dacron.

Staying Healthy

• Regardless of how the PAD is managed, part of the care is strict attention to managing the risk factors that cause PAD.
• Avoid tobacco use. If you smoke, ask your vascular surgeon to help you find a smoking cessation program that will work for you.
• Exercise regularly.
• Take prescribed medications as recommended to control high blood pressure, high cholesterol or triglycerides, diabetes, and kidney failure.
• Lose weight to decrease the amount of work your muscles need to do when you walk.
• Eat a balanced, low-sodium, low-fat diet.
• See your vascular surgeon for regular scheduled follow ups to keep small problems from turning into big problems.