Vascular & Endovascular Surgery
Peripheral Arterial Disease
Peripheral arterial disease (PAD) is one of the most under diagnosed health conditions in the US and is an important indicator that more serious vascular health conditions may be present in other areas of the body. For this reason PAD is a significant predictor of heart attack and stroke.
PAD occurs when the arteries in your legs become narrowed with plaque and cannot bring enough blood to your leg and foot. This condition is a complication of atherosclerosis (or hardening of the arteries). Arteries are the vessels in your body that supply all the oxygen-rich blood the muscles need to function. When artery walls thicken with plaque, which is made of cholesterol, you have the condition called atherosclerosis. When blood flow in your legs is reduced by atherosclerosis, you will start to see the symptoms of peripheral arterial disease.
During the first stages of PAD, your arteries still provide enough oxygen to your muscles during rest. However, when you are active, such as when you are walking or climbing stairs, your muscles need more oxygen than the narrowed vessels can supply. As a result, the muscles may cramp or feel tired.
As the disease progresses, you may develop pain in the foot and/or leg at rest due to lack of blood flow. This may result in the loss of a limb due to tissue and muscle death (i.e. gangrene).
Risk Factors for Atherosclerosis and PAD
There are many risk factors for atherosclerosis and PAD. Making changes in your lifestyle or taking medications your doctor prescribes can reduce your risk.
- Cigarette smoking
- High cholesterol or a high fat diet, or both
- Hypertension (high blood pressure)
- Age over 60
- Family history
- Excessive alcohol use
- Sedentary lifestyle
Symptoms of Peripheral Arterial Disease
- Cramping or aching in your hip, buttocks, thighs, or calves after a short walk. This pain is called claudication. The pain goes away when you stop the activity, but returns when you move again.
- Pain in your hip, buttocks, thighs, or calves that increases when you climb stairs or go uphill.
- Pain in a limb when you are resting. This is a symptom of severe PAD.
Diagnosing Peripheral Arterial Disease
Your Medical Evaluation
The three main components of diagnosing peripheral arterial disease are a history and physical exam by the doctor, a study of your blood flow in the vascular laboratory, and an imaging study called an arteriogram, which will pinpoint where the problems are.
Your health history: You’ll be asked numerous questions about the symptoms and risk factors you may have for PAD. Try to be specific and mention all your concerns, even if you don’t think they are related: they could reveal an underlying symptom. List all your medications, including aspirin, blood thinners, and over-the-counter supplements.
Physical exam: Plaque can form in blood vessels throughout your body. For this reason, your doctor will feel for pulses and listen to blood flow in your major arteries. Your neck, upper arms and abdomen are also likely to be checked. Your feet and legs will be examined carefully for signs for PAD, which include nail changes, changes in skin color and temperature, and sores that will not heal.
If you have PAD, the arteries that carry blood to the heart or brain may also be affected. This puts you at risk for heart attack or stroke.
Tests that Measure Blood Flow: A vascular technician will test the blood flow in your legs and feet. There are several quick and painless tests that will confirm the diagnosis and extent of PAD.
- An ankle-brachial index (ABI) is a series of blood pressure readings that compares the blood pressure in your ankle and foot with the blood pressure in your arm.
- Doppler ultrasound, which looks at the blood flowing through your arteries. It can show changes in blood flow due to narrowing or blockage of an artery.
Arteriography: If you are diagnosed with peripheral arterial disease, your doctor may perform an arteriogram to locate the damage to your arteries and determine its extent. This test may only take a couple hours and is usually done on an outpatient basis, but with recovery time you should allow a full day.
Before the procedure, you’ll be given medication to make you comfortable. After the area is numbed, a long, thin tube called a catheter will be inserted into an artery, usually one of the femoral arteries, through a small puncture in one of your groins. The doctor will carefully thread the catheter through the affected artery, and once it is in place, will inject a contrast dye. The dye shows up clearly on the X-rays, to pinpoint where the artery is narrowed or blocked. After the procedure, you will be monitored while you rest with your leg straight for several hours. Most patients resume their normal activities the following day.
Treatment of Peripheral Arterial Disease
There are some steps you can take to reduce arterial damage caused by kidney damage atherosclerosis.They include:
- Stop smoking right away
- Use a thrombolytic or fibrinolytic drug if prescribed by your doctor to dissolve clots and relieve the pain of claudication
- If you have severe peripheral arterial disease, particularly if it does not improve with the measures described above, your doctor may recommend a minimally invasive endovascular treatment to improve the circulation in your legs. If the blockage is more extensive or cannot be treated with an endovascular procedure, bypass surgery may be required.
Endovascular Procedures for Peripheral Arterial Disease
Angioplasty and stenting are endovascular procedures that may be used to repair a severely narrowed artery or a short blockage. Both can be done through a small puncture, usually at the groin. As a result, general anesthesia isn’t needed, so recovery can be much quicker and complications fewer than with open bypass surgery.
Angioplasty uses a tiny balloon to open blocked arteries. The balloon is inflated and deflated several times to press the plaque against the artery wall. Once the artery has been unblocked, the balloon is deflated and removed. Blood can flow freely through the widened artery.
Stenting is the insertion of a tiny wire mesh tube into an artery to hold it open. The collapsed stent is mounted onto a balloon catheter and guided across the blockage. The balloon is inflated to open the stent, which locks into place inside the artery. The balloon is deflated and removed, leaving the stent in place to hold the artery open.