Peripheral Arterial Disease

Peripheral Arterial Disease, or PAD, is the narrowing of the arteries to the arms or legs. It occurs when atherosclerotic plaque adheres to the lining of the arteries, which then blocks the path for blood flow.

PAD can cause poor circulation and the decrease in blood to your arms or legs may result in pain, non-healing infections, or wounds 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 with PAD are at risk of having a heart attack within 5 years.

Do I Have Peripheral Arterial Disease?

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 tingling
• Impotence
• Difference in blood pressure from one arm to the other

Common Risk Factors

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

Diagnosis

Since the symptoms are similar to other diseases, we need to perform a thorough history and physical examination as an initial evaluation tool.

Based on your symptoms and the findings of the exam, we may recommend further evaluation. This typically begins 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 we detect a significant blockage and we recommend treatment, we may recommend more invasive tests. These invasive tests 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 we give the patient a mild sedative before and during the procedure, and inject the area over the artery 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.

Treatment Options

Treatment options for peripheral arterial disease include angioplasty, stenting, and bypass surgery.