Peripheral Arterial Disease


Description
Peripheral Arterial Disease, or PAD, is the narrowing of the arteries to the arms or legs. It is caused by atherosclerotic plaque adhering to the lining of the arteries which then blocks the path for the blood to flow through. PAD can cause “poor circulation” and the decrease in blood to your arms or legs may result in pain, non-healing infections or wounds (gangrene) that can even result in amputations.  PAD is also a well-known marker of atherosclerotic plaque in the coronary (heart) arteries and nearly 40% of people found to have PAD are at risk of having a heart attack within 5 years.

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Common Risk Factors

  • Smoking
  • High cholesterol
  • Diabetes
  • High blood pressure
  • Obesity

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Symptoms

Approximately eight to 12 million Americans have PAD. The disease develops slowly for up to 20 years and usually begins without symptoms. Over the years, though, patients may experience

  • Pain or cramping in their calves, thighs or buttocks muscles during walking or other activities. (These characteristic symptoms are called claudication and are often mistaken for arthritis or sciatica)
  • Pain in the muscles of their arms when exercising
  • Pain, usually described as a “burning ache,” in the feet that typically occurs at rest
  • A shallow wound, or “ulcer,” that is painful, slow to heal or worsening
  • Fatigue of the legs or arms
  • Numbness, or “coolness”
  • Impotence
  • Difference in blood pressure from one arm to the other

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Tests and Diagnosis:

Because the symptoms are similar to other diseases, it is necessary to have a doctor perform a thorough history and physical examination as an initial evaluation tool.  Based on your symptoms and the findings of the exam your surgeon may recommend further evaluation, typically beginning with relatively simple, non-invasive, office-based tests such as:

Ankle-brachial Index (ABI).  This test measures the ratio of the blood pressures of your ankle and arm and is an excellent first-line screening test to detect significant PAD

Segmental Pressure Recordings (SPR). This test involves measuring the arterial pressure at various levels along the limb to detect and locate the areas of blockage

Arterial Duplex Ultrasound (DUS). An ultrasound examination to visualize blockages and measure their resistance to normal blood flow

If a significant blockage is detected and treatment is recommended or planned your surgeon may recommend tests that are more “invasive” – invasive in the sense that they require placement of a catheter into an artery or vein in order to obtain more information.

Angiography.  This involves injecting contrast agents (“dye”) through a catheter into an artery.  Typically the patient is given a mild sedative before and during the procedure and the area over the artery, usually in the groin or elbow, is injected with a local anesthetic.  Injecting the dye into the artery or vein creates an image called an “angiogram” that provides the detail necessary to plan out the proper treatment for you.

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Treatment options

Angioplasty

Angioplasty is a “catheter-based” procedure that improves the flow of blood within the arteries. Catheter-based procedures are typically “in-and-out” procedures that do not require overnight hospitalization.  Patients are given a mild sedative and local anesthetic during the procedure.  The surgeon inserts a balloon-tipped catheter into the artery and places it across the blockage. The balloon is inflated to open the artery and the catheter is removed.

Stenting

Stenting is another catheter-based  procedure used to open up blockages in arteries and veins.  Similar to an angioplasty your surgeon inserts a catheter across a blockage and then deploys a “stent” within the vessel.  A stent is a fine, metal wire, mesh cylinder that will keep the artery propped open like scaffolding.  The decision to use angioplasty or stenting, or both, depends on several factors that your surgeon will explain to you.

Bypass Surgery

Peripheral artery bypass surgery is used to restore adequate blood flow around blockages.  In this procedure your surgeon uses one of your own veins, usually from the same leg, and connects it to an artery above the blockage and then again further below the blockage.  If you do not have a suitable vein to support high blood flow your surgeon may use a synthetic graft as the bypass.   This surgery is typically done under a general anesthetic because it requires making incisions on your leg.  Most patients experience a post-operative hospital stay of three to five days.

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FAQs

What is PAD?
Peripheral Arterial Disease. A condition where plaque builds up in arteries of the body leading to partial or complete blockage of blood flow.  This can cause weakness or pain in your legs, poor healing wounds or difficult walking.

What can be done if I have PAD?

 Depending on the severity of blockage a variety of things can be done ranging from medicine, angioplasty and stenting without any major surgery or bypass procedures.

Does insurance cover evaluation and treatment of PAD?
Yes.

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Helpful Links

Please visit these websites for detailed information directed to patients and their families:

http://www.vascularweb.org/vascularhealth/pages/peripheralarterydisease(PAD).aspx

http://www.vascularweb.org/vascularhealth/pages/armarterydisease.aspx

http://www.webmd.com/heart-disease/tc/peripheral-arterial-disease-of-the-legs-treatment-overview  

http://en.wikipedia.org/wiki/Peripheral_vascular_disease

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