Peripheral Arterial Disease (PAD)

What is Peripheral Arterial Disease?

Peripheral arterial disease (PAD) is a circulatory disorder characterized by narrowing of the blood vessels, usually in the legs. The condition is usually caused by atherosclerosis, a buildup of plaque (fatty substances) along the inner wall of the arteries. In this way, it is very similar to coronary artery disease, except that a different region of the body is affected. Blood clots can also form and cause similar 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, patients may experience fatigue, numbness, pain or cramping in their calves, thighs or buttocks muscles during walking or other activities. The pain is caused because not enough oxygen can reach the muscles and surrounding tissue. These characteristic symptoms are called claudication.Often times, the symptoms are mistaken for arthritis or sciatica. Because the symptoms are similar to other diseases, it is necessary to have a doctor perform an ankle-brachial index (ABI) or ankle blood pressure measurement test to determine if you have PAD.

Risk Factors Include:

  • High Blood Pressure
  • History of Smoking
  • High Cholesterol
  • Family History of Heart Disease
  • Physical Inactivity
  • Diabetes
  • Obesity
  • Being older than age 55

Patients who have PAD are at risk for Heart Attack, Stroke, Aneurysm and loss of Limbs.

How is PAD Detected?

A Vascular Specialist will use non-invasive testing to determine the presence and level of arterial disease. To detect PAD in the legs, the most common method of disease detection is ABI, or Ankle Brachial Index. ABI tests the quality of circulation in the legs by comparing the systolic blood pressure in the ankle to the systolic blood pressure in the arm.  A blood pressure at the ankle that is lower than the blood pressure at the arm suggests the presence of disease, or narrowing of the arteries due to plaque build-up.If the blood pressure in the leg is less than half the blood pressure in the arm, your doctor may suggest more advanced diagnostic testing to determine the level and exact location of the arterial blockage, or your doctor may suggest intervention.

What are the Treatment Options for PAD?

Medication, exercise, quitting smoking, and other therapies may help patients with occasional symptoms and intermittent claudication. But for patients who experience persistent pain when resting, ulcers, gangrene, or severely limited activity as a result of PAD, revascularization is often the only solution. Intervention can prevent the symptoms and disease from worsening-in very extreme cases, PAD can progress to the point that amputation is required.Depending on the severity and length of the blockage, different treatments may be prescribed. For localized blockages, angioplasty and/or stents may correct the problem. For longer segments of blockage, bypass is usually recommended. In either case, the procedures are similar to those used to treat coronary arteries on the heart.

What Takes Place During Treatment?

For relatively small blockages, angioplasty is often an effective treatment. A catheter with a balloon device attached is inserted in the arteries, and the balloon is inflated to stretch open the narrowed artery. This allows blood to flow more easily through the artery throughout the leg or other extremity. A stent (a small metal cage device) may be placed in the artery to help keep the vessel open once the balloon is removed. These procedures can be done as an outpatient-recovery is rapid.

When angioplasty and stent placement can not be done, a surgical bypass of the blockage is another option. The bypass may be a vein from your own body (usually the leg) or made of synthetic material. The surgeon attaches the graft to the diseased artery on either side of the blocked area.This creates a new channel through which the blood can flow and allows oxygenated blood to travel to the leg and foot below the blockage, thus reducing or eliminating the pain associated with PAD in addition to the amputation risk.Recovery following a surgical revascularization usually includes about one week in the hospital. Since this is a relatively invasive procedure, full recovery may take six to eight weeks.

Vascular Access for Dialysis

People who have been diagnosed with kidney failure need another method to filter the blood and toxins out of their body. To perform hemodialysis dialysis, in which the toxins can be cleaned out vessels need to be prepared for access.

Hemodialysis access involves extracting blood out of the body and filtering it through machine that extracts extra fluid and corrects the chemicals in the blood. In order to remove blood from the body, needles are placed into the skin into a vessel that is prepared for dialysis. One method for preparing access is called a fistula. To create this, a small incision is made on the arm and a vein is connected to one of the arteries in the arm. This vein then enlarges over time and can be stuck over and over to perform dialysis. This method is preferred by CRL surgeons as the best type because of its longevity (often many years) and low resistance to infection.

Another type of vascular access is called a dialysis graft. It is used when a suitable vein is not available. It is not as desirable because of its higher risk of infection and because it does not last as long as a fistula. To create this, an artificial tube is tunneled between an artery and a vein. This tube is then stuck with needles to perform dialysis.The third type of hemodialysis access is accomplished by placing a silicone catheter in one of the veins of the neck.The catheter is then tunneled under the skin and its ends are situated on the chest wall. This allows for a patient to be connected to the dialysis machine directly. It is a desirable method for access in patients who have rapid deterioration in their kidney function and need dialysis quickly.