Peripheral Artery Disease

A common condition, peripheral artery disease (PAD) often causes painful muscle cramping in the hips, thighs, or calves. The pain starts while you are exercising, but continues after you stop. PAD increases your risk of coronary heart disease, heart attack, and stroke.

About Peripheral Artery Disease

Peripheral arteries bring oxygen-rich blood to your arms and legs—the outer areas of the body. When they become narrow or blocked, it makes it difficult for blood to flow normally. We call this condition peripheral artery disease or PAD.

In its early stages, PAD causes painful cramping while you walk. If the disease progresses, you may cause variety of other symptoms:

  • Coldness or numbness in your arms, legs, fingers, or toes
  • Erectile dysfunction
  • Loss of sensation in your arms or legs
  • Non-healing wounds or skin ulcers
  • Pain in the feet and color change
  • Thinning or loss of hair on the arms and legs 

Your risk of PAD increases as you get older. Other risk factors for PAD include:

  • Accumulation of fat in the arteries (atherosclerosis)
  • Diabetes
  • Family history of PAD
  • High blood pressure (hypertension)
  • High cholesterol
  • Obesity
  • Physical inactivity
  • Renal disease
  • Smoking

Diagnosis and Treatment

To diagnose PAD, we start with a thorough physical exam. We also use a variety of tests including:

  • Angiography is an imaging test that allows us to see the arteries in your abdomen, pelvis, and legs, using contrast dye that we insert through a catheter placed in your arteries
  • Ankle-brachial index is a painless exam that compares the blood pressure in the leg to the blood pressure in the arm.
  • Arterial or venous duplex ultrasounds use sound waves to let us measure blood flow in your arteries, to determine if there’s blockage.
  • Computerized tomography  employs X-rays to create detailed pictures of your heart and arteries.
  • Echocardiograms use sound waves to create pictures of your heart’s chambers, valves, and walls, as well as the arteries and veins attached to your heart.
  • Magnetic resonance imaging (MRI) takes advantage of magnets and radio wave technology to capture images of your arteries

Although PAD cannot be cured, we can reduce symptoms, help your heart work better, and prevent future problems such as heart attack or stroke. We may start by recommending lifestyle changes such as exercising, losing weight, and quitting smoking. We may also prescribe medications.

In certain cases, we offer a variety of minimally invasive and open surgical procedures that can help. Minimally invasive (endovascular) procedures include:

  • Balloon angioplasty involves inserting a thin tube (catheter) with a balloon on the tip into your artery, moving it to the location of the PAD, and then inflating it to open your artery and restore blood flow.
  • Laser atherectomy uses a catheter that emits high-energy light, called a laser, to vaporize the blockage and increase blood flow through the artery.
  • Rotational atherectomy using a catheter with a revolving blade to break the plaque that is blocking blood flow into tiny pieces that can pass through the blood vessel.
  • Stent implantation is similar to angioplasty. We insert a catheter with a balloon on the end into the problem area and inflate the balloon to open up the artery. Then we use a second device to insert a stent, which we expand, to hold the artery open. The stent remains in your artery to keep your blood flowing properly.

A more invasive procedure is called endartectomy. When we perform this surgical procedure, we make an incision in the neck, which allows us to reach the artery with the blockage, usually the femoral artery. We then remove the plaque that has built up and is preventing blood flow. You may need to stay in the hospital for a day or two after this procedure.

If we determine that you are not a good candidate for any of these options, we may perform bypass surgery. This procedure creates an alternate route for your blood to pass through. We make incisions above and below your blocked artery and attach a blood vessel made of synthetic material, or taken from another part of your body, and connect it to the existing blood vessel. The purpose is to redirect the blood flow around the blocked section (bypass).  You will probably be in the hospital for several days after this procedure.