Peripheral Arterial Disease (PAD)

What is Peripheral Arterial Disease (PAD)?

Peripheral arteries bring blood from the heart to the outer areas of the body. Peripheral arterial disease (PAD) is caused by a narrowing of the peripheral arteries to the brain, stomach, kidneys, legs, arms, and other body parts - most commonly in the arteries of the legs. 

Normally blood flows easily through arteries to all parts of the body but sometimes fatty deposits (atherosclerosis) build up inside the walls of the arteries causing it to become narrow or blocked leading to a reduced flow of oxygen-rich blood to the limbs. When muscles of the limbs do not get enough blood, symptoms then occur.

How do I know if I have Peripheral Arterial Disease (PAD)?

Most patients develop PAD with no obvious symptoms while others complain painful muscle cramping or aching in the hops, thigh or calves when walking, climbing stairs or exercising. Typically, the pain goes away with rest and returns when you resume walking (intermittent claudication). If PAD is severe, you may experience skin ulceration or non-healing wounds in the foot or toes, coldness or numbness in the arms, legs, thigh or toes, and erectile dysfunction in men.

Those who smoke, have diabetes and high cholesterol are at high risk for PAD. Other risk factors include advanced age, family history of PAD, coronary artery disease (CAD) and stroke, obesity, physical inactivity, and high blood pressure.

What happens when I have PAD?

When the blockage remains in the peripheral arteries in the legs, you may experience the following:

• Pain leading to difficulty in walking
• Changes in the skin color
• Thinning or loss of hair in your legs
• Loss of sensation giving rise to non-healing wounds or ulcers.
• A total loss of circulation to your legs and feet can cause gangrene and eventually loss of a limb.

If the blockage happens in the carotid artery, it can cause a stroke. Patients with PAD have an increased risk of coronary artery disease and stroke or brain attack.

How is PAD diagnosed?

Diagnosis of PAD is based on a history of typical symptoms described above, and physical examination findings such as weak or absent pulses in the extremeties. This can be confirmed by decreased blood pressure in the legs by doing an ankle-brachial index (ABI) at rest and during exercise (stress ABI). If you ABI is less than 0.9, you most likely have PAD and you may need more tests such as:

Arterial Duplex Ultrasound: a non-invasive method that visualizes the artery using ultrasound, and measures blood flow to help identify sites of blockage.

Computed Tomographic Angiography (CT Angiography): a non-invasive test that can image the arteries in our abdomen, pelvis and legs using X-ray.

Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without using X-rays.

Contrast Angiography: During contrast angiogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow in the arteries in the legs more clearly to help pinpoint any blockages that may be present.

What are the available treatment options?

The goals of treatment of PAD are reduce symptoms, improve walking capacity and prevent further progression of the disease, death due to heart attack or stroke and loss of limb.

Medications: antiplatelet agents, drugs that lower cholesterol levels, control hypertension and diabetes, medications to improve walking distance.

Lifestyle modifications: (such as quitting smoking and losing weight) are effective. It is indicated for all patients with heart disease, prior heart attack and stroke, hypertension, regardless of drug therapy. It may reduce, or even abolish, the need for antihypertensive drugs.

Vascular Rehabilitation program: Patients who have pain in one or both legs when walking or intermittent claudication will benefit from enrolling in an exercise rehabilitation program supervised by healthcare professionals such as doctors, nurses, and physical therapists. These patients are trained to walk longer distances by engaging in regular supervised walking exercises on a treadmill machine.

Revascularization: In severe cases, angiogplasty, a nonsurgical method, may be performed by making a small incision in the groin through which a catheter is inserted then a balloon or stent is used to open up the blocked artery. Other patients may need bypass surgery, which replaces the diseased vessel with a vein in another part of the body or a synthetic graft, that reestablishes flow to the distal parts of the limb.

What are the related services available at The Medical City?

At The Medical City, we have a complete roster of competent vascular medicine specialists, vascular surgeons and interventional cardiologists who can assess and treat patients with PAD.

The following services/tests are available:

1. Rest and stress ABI

2. Arterial duplex study

3. Six-minute walk test

4. CT angiography

5. Vascular Rehabilitation for supervised exercise program

6. Contrast Angiography

7. Vascular Rehabilitation for supervised exercise program

8. Peripheral angioplasty

9. Peripheral bypass surgery

REFERENCES:

1. Creager, Mark et al. Vascular Medicine, 2nd edition.

2. http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease

3. http://www.mayoclinic.org/disease-conditions/peripheral-artery-disease

4. http://www.medicinenet.com/peripheral vascular disease

5. TMC: Department of Medicine - Section of Cardiology-Subsection of Vascular Medicine

6. Center for Patient Partnership

For more information, please call:

CARDIAC AND PERIPHERAL LABORATORY

Tel. no.: (632) 988-1000 / (632) 988-7000 ext. 6299/6461

CENTER FOR PATIENT PARTNERSHIP

Tel. no.: (632) 988-1000 / (632) 988-7000 ext. 6444

Note:   This information is not intended to be used as a substitute for professional medical advice, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.