Peripheral Arterial Disease

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. 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. The disease develops slowly for up to 20 years and usually begins without symptoms.

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

 

Symptoms

  • Fatigue, numbness, pain or cramping in their calves, thighs or buttocks muscles during walking or other activities (claudication)

  • Coldness in the lower leg or foot

  • No pulse or weak pulse in legs or feet

  • Shiny skin on the legs

  • Sores on the lower extremities that won’t heal

 

Diagnosis

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. 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. Physicians may also use ultrasound or angiography to check blood flow or look for blockages.

 

Treatment Options

Medication, exercise, quitting smoking, and other therapies may help patients with occasional symptoms and intermittent claudication.

Angioplasty

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.

Surgical Bypass

When angioplasty and stent placement cannot 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 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.