Peripheral Artery Disease (PAD)
Peripheral artery disease (PAD) is the narrowing of the arteries to the legs, stomach, arms and head. PAD (also called PVD, or peripheral vascular disease) is most common in the arteries in the pelvis and legs. It is a form of atherosclerosis (cholesterol build-up) caused by the collection of fatty deposits and other substances in the arteries. It can be difficult to know if you have PAD. Many people with PAD have little or no symptoms. Others have pain in their legs while they walk and the pain usually goes away when they rest.
Symptoms of PAD
The most common symptom is muscle cramping in the hips, thighs or calves while walking, climbing stairs or exercising. This usually goes away when the activity stops. It’s called “claudication.” Other severe symptoms include:
- Leg pain that doesn’t go away when you stop exercising
- Foot or toe wounds that won’t heal or heal very slowly
- Gangrene, or dead tissue
- A marked decrease in the temperature of your lower leg or foot, compared to the other leg or the rest of your body
- Poor nail growth on the toes or poor hair growth on the legs
- Erectile dysfunction, especially in men with Diabetes
Risk Factors for PAD
You may be at a higher risk for PAD if you fall into one or more of these risk categories:
- 50 years or older
- Family members with the disease
- High cholesterol or high blood pressure
- Kidney disease
Diagnosis of PAD
Along with a complete medical history and physical exam, other tests may include:
Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device. To determine the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.
Doppler ultrasound flow studies. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Your doctor may use the Doppler technique to measure and assess the flow of blood. Faintness or absence of sound may mean blood flow is blocked.
Computed Tomography Angiography (CTA). This noninvasive test uses a CT scanner and a computer to produce detailed images of organs and structures in the body. Your doctor injects a special dye during the procedure so that blood vessels are more visible.
Treatments for Peripheral Arterial Disease (PAD)
The main goals for treatment of PAD are to control the symptoms and halt the progression of the disease to lower the risk for heart attack, stroke, and other complications.
Treatment may include:
- Lifestyle changes to control risk factors, including regular exercise, proper nutrition, and quitting smoking
- Aggressive treatment of existing conditions that may worsen PAD, such as diabetes, high blood pressure, and high cholesterol
- Medicines to improve blood flow, such as antiplatelet agents (blood thinners) and medicines that relax the blood vessel walls
- Vascular surgery —a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow
- Angioplasty — your doctor inserts a catheter (long hollow tube) to create a larger opening in an artery to increase blood flow. There are several types of angioplasty procedures, including: Balloon angioplasty (a small balloon is inflated inside the blocked artery to open the blocked area)
- Atherectomy (the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter)
- Laser angioplasty (a laser is used to "vaporize" the blockage in the artery) Stent (a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open).
Complications of PAD
Complications of PAD most often occur because of decreased or absent blood flow.
Such complications may include:
- Amputation (loss of a limb)
- Poor wound healing
- Restricted mobility due to pain or discomfort
- Severe pain in the affected extremity
- Stroke (3 times more likely in people with PAD)
- Following an aggressive treatment plan for PAD can help prevent complications.
Prevention of PAD
To prevent PAD, take steps to manage the risk factors. A prevention program for PAD may include:
- Quit smoking, including avoidance of second hand smoke and use of any tobacco products
- Dietary changes including reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables, low-fat dairy, and lean meats
- Treatment of high blood cholesterol with medicine as determined by your healthcare provider
- Weight loss
- Limiting or quitting alcohol intake
- Medicine to reduce your risk for blood clots, as determined by your healthcare provider
- Exercise 30 minutes or more daily
- Control of diabetes
- Control of high blood pressure
Heart Conditions We Treat
- Aortic Stenosis
- Atrial Fibrillation
- Chest Pain
- Congestive Heart Failure
- Coronary Artery Disease
- Heart Attack
- Heart Disease
- Heart Valve Disease
- High Blood Pressure
- High Cholesterol
- Low Blood Pressure
- Mitral Valve Disease and Regurgitation
- Peripheral Artery Disease (PAD) Treatment
- Pulmonary Hypertension
- Vascular Disease