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
Leg Pain? Experts Dr. Ghosheh and Dr. Hacioglu Discuss Vascular Issues
When it comes to cardiac health, vascular diseases are probably not the first thing that comes to mind. However, vascular diseases like peripheral artery disease (PAD) and venous insufficiency are common and sometimes overlooked. Dr. Yazan Ghosheh, and Dr. Yalcin Hacioglu answer questions about vascular disease.
PAD with Dr. Yazan Ghosheh
What is peripheral artery disease (PAD)?
PAD is the narrowing of the arteries to the legs, stomach, arms and head. It is most common in the arteries of the legs and pelvis. PAD can result from a condition known
as atherosclerosis, where a waxy substance called plaque forms inside the arteries.
When enough plaque builds up on the inside of an artery, the artery becomes clogged, and blood flow is slowed or stopped. This can cause pain and cramping in the legs.
How do you diagnose and treat PAD?
PAD diagnosis starts with knowing the patient’s history and examining them. If we determine a patient may have PAD, we can do a simple test comparing the patient’s blood pressure in their ankle to the blood pressure in their arms. Depending on the results of that test, we may also do a Doppler ultrasound or use other imaging techniques. Once we have a diagnosis, the treatment plan can include lifestyle changes, medication or minimally invasive procedures such as angioplasty or stent placement.
What causes PAD?
PAD is mostly caused by plaque buildup in the arteries, which narrows them and restricts blood flow.
How can I reduce my risk of developing PAD?
Some risk factors are not controllable, including aging and a personal or family history of PAD, cardiovascular disease or stroke. However, risk factors that you can control include smoking, diabetes, being overweight or obese, high cholesterol, high blood pressure and low physical activity.
Venous Insufficiency with Dr. Yalcin Hacioglu
How would you describe venous insufficiency and its symptoms?
Venous insufficiency is the failure of veins to maintain unidirectional (or one-way) flow
of blood from the legs back to the heart due to dysfunctional vein valves on major superficial or deep leg veins. This can cause a variety of symptoms, including swelling or discomfort in the legs, restless legs, itching, eczema, bulging varicose veins, redness or
hyperpigmentation of skin, thickening and stiffening of the skin, deformed toe nails, cellulitis and skin ulcers.
How do you treat venous insufficiency?
For patients who may have venous insufficiency, we perform a Doppler ultrasound study
that helps us determine what path treatment will take. Some patients are treated with minimally invasive techniques, such as compression stockings, lifestyle modifications and exercises such as leg elevation or calf pumping. For more serious cases, procedures including sclerotherapy—a common treatment for varicose veins—and radiofrequency ablations are available.
What causes venous insufficiency?
Venous insufficiency can be caused by any condition that disrupts normal vein valve function. This can include trauma, inflammation, obstruction, genetic predisposition and other conditions that can cause increased central venous pressure, such as heart
failure or pulmonary hypertension.
How can venous insufficiency be prevented?
Like many cardiovascular conditions, one important way to prevent venous insufficiency is maintaining a healthy body weight. You can also help prevent it by avoiding prolonged standing, establishing regular walking exercises, and being aware of its symptoms so you can catch it and treat it early.
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