What is Peripheral Artery Disease?
Peripheral Arterial Disease, or PAD, occurs when the arteries in your legs and/or arms become narrowed or clogged with plaque or fatty deposits (atherosclerosis), creating blockages or venous insufficiency in your blood vessels. The buildup causes decreased blood flow to your legs and feet, leaving the muscles in your legs and feet starved for oxygen and blood supply. When the blood flow to the legs is greatly reduced, you can have trouble walking (intermittent claudication) and if left untreated, could result in Critical Limb Ischemia. In the most severe cases, PAD can lead to the amputation of a toe, foot or leg. PAD is also called Peripheral Vascular Disease, or PVD.
PAD Quick Facts
- 8 to 12 million people in the United States have PAD
- 12 to 20% (4.5 to 7.6 million) of those who have PAD are over 65 years of age
- By 2050, a projected 19 million people will have PAD
- Patients who suffer from either peripheral or coronary artery disease appear to be at a higher risk for the development of both conditions
- If left untreated PAD can lead to Critical Limb Ischemia (CLI) which can result in gangrene and even amputation
- 1 out of every 3 people with diabetes over the age of 50 has PAD
What Are the Risk Factors for PAD?
Those that are at high risk should be screened for this disease. Early detection and prevention can help prevent disease progression. Risk factors include:
- Over 50 years old
- Smoke or used to smoke
- High blood pressure
- High cholesterol levels
- Family or personal history of vascular disease
What Are the Symptoms of PAD?
Many patients associate pain or weakness in their legs as a normal part of aging, but the underlying cause may be more serious. Intermittent Claudication is a symptom of Peripheral Arterial Disease (PAD). Intermittent Claudication is a condition that occurs during activity when there is not enough blood reaching specific arteries in the legs. The decreased blood flow occurs because of blockages in the arteries. PAD is caused by atherosclerosis, the hardening and narrowing of the arteries in the lower extremities due to the buildup of fatty deposits called plaque. The most common feature of Intermittent Claudication includes severe calf and/or buttock pain during activity that subsides with rest.
Other symptoms of Peripheral Artery Disease (PAD) include:
- Leg numbness and weakness when walking or exercising that disappears when activity stops
- Coldness, numbness or tingling in the lower legs and feet
- Pain in legs or feet that disrupts sleep
- Ulcers or sores on legs and feet that won’t heal
- Erectile dysfunction in men
How is PAD Diagnosed?
Though PAD can be very painful, the tests for it can be quick and painless—as simple as a blood pressure measurement. These painless exams measure blood flow into the extremities.
Ankle-brachial Index (ABI)
This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm. Your provider will use a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. The blood pressure at the ankle and upper arm should be roughly equal. If the pressure in the ankle is significantly less, peripheral artery disease is present. Not only is the ABI one of the most reliable tests for PAD, it is also the least expensive. An extension of this test is the toe brachial index, which gives more information about the blood flow to the feet.
Skin Perfusion Pressures and Transcutaneous Oxygen Tension
Skin Perfusion Pressure Test (SPP) and Transcutaneous Oximetry Test (TcPO2) measure the amount of blood flow in different parts of the foot. They help determine if a wound or ulcer will heal on its own or if it needs more blood flow to heal the wound. During the SPP test, the patient lies flat while a small sensor is placed near the wound, and a blood pressure cuff is placed over the sensor. The test determines how much blood is flowing around the test site. During the TcPO2 test, small sensors are placed around the wound. The sensors measure the amount of oxygen getting to the wounds.
Special ultrasound imaging techniques, such as Doppler ultrasound, can help your provider evaluate blood flow through blood vessels and identify blocked or narrowed arteries.
An angiogram, or angiography, is a procedure that can show the severity and location of blockages. This X-ray test uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in an artery. This test can also be done using CT and MRI. During an angiogram, a catheter is placed into a blood vessel in the groin (femoral artery or vein) or just above the elbow (brachial artery or vein). The catheter is guided to the area to be studied. Then, contrast material is injected into the vessel in order to view blood flow through the arteries. This type of angiography allows for simultaneous diagnosis and treatment by finding the narrowed area of a blood vessel and then widening it with an angioplasty procedure or administering medication to improve blood flow.
How is PAD Treated?
There are two methods of treating blockages in the arteries supplying the legs: surgery and endovascular revascularization. At CDI Vascular Care, we specialize in non-surgical endovascular revascularization techniques.
During bypass surgery, the surgeon makes an opening above and below the blockage in the diseased vein and connects a graft, which is a special fabric or a portion of a normal vein taken from another site in the body, to these openings. This reroutes the blood through the bypass around the blockage. This technique requires a hospital stay, physical therapy and anticoagulation medication.
This procedure is used to open up blocked arteries from inside the vein. During this procedure, the interventional radiologist inserts 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 location of the blockages and type of symptoms you have will help the doctor determine the best way to treat your blockages. The options include:
- Angioplasty — a catheter with a balloon is passed through the blocked artery. Once inflated, the balloon compresses the plaque against the wall of the artery.
- Stent implantation — during angioplasty, a tiny metal mesh tube called a stent may be placed in the artery to help hold it open.
- Atherectomy — a special catheter is used to gently shave and remove plaque from the arteries
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