Peripheral Artery Disease, PAD

A common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop peripheral artery disease, your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking. Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries. This condition may be reducing blood flow to your heart and brain, as well as your legs.

Pearl

PAD affecting the legs might be an indicator of a larger problem affecting the heart and brain arteries.

What is PAD?

Peripheral artery disease occurs when cholesterol and other fats attach to an artery wall, a problem more likely to occur when the wall has experienced damage due to an underlying condition such as high blood pressure or diabetes. Over time, calcium and other substances join the fats, making the plaque slowly enlarge and harden. This condition, called atherosclerosis, narrows the artery and restricts blood flow through the vessel.

What are the symptoms of PAD?

These depend on the location of the arteries affected. When it affects arteries supplying blood to the legs, you might develop symptoms like:

  • Leg pain while walking that feels better after resting (claudication)
  • Leg fatigue, numbness, or heaviness
  • Leg or foot discoloration
  • Non-healing leg or foot wounds, ulcers or gangrene
  • Hair loss or slow hair growth on the leg

When PAD goes untreated, the lack of oxygen-rich blood causes critical limb ischemia. Without oxygen, skin and other tissues deteriorate, and dangerous infections and gangrene can develop.

How is PAD diagnosed?

  • A thorough history focusing on risk factors like age, high blood pressure, smoking, family history, and history of heart disease
  • A complete physical exam with special attention to the neck arteries, heart sounds, and pulses in the legs
  • Simple non-invasive tests include:
    • Ankle-Brachial Index:
      in which a pressure cuff is placed on the arm and both legs and the pressure ratio between them is calculated
    • QuantaFlo:
      an innovative device the quickly assesses the flow of blood in the arm and legs using volume plethysmography
  • Duplex ultrasound:
    in which an external US (no radiation) is used to look inside the arteries and evaluate for any narrowing or blockage. It also measures how fast the blood is moving inside the arteries, which allows us to estimate the degree of narrowing.
  • CT:
    This usually requires the placement of an IV to introduce a dye into the arteries and involves radiation, but can provide a roadmap of the arteries that is extremely helpful
  • Diagnostic angiogram:
    This is an invasive procedure that usually requires sedation and direct access to arteries, typically in the groin. It requires injection of dye directly in the artery. It can be both diagnostic and therapeutic.

How is PAD treated?

Medical/conservative therapy

  • Many patients with PAD have mild symptoms and do not require an intervention.
  • Aspirin or Plavix (alone or in combination) along with a cholesterol lowering drug. This also helps reduce the risk of a heart attack and stroke
  • Pletal: A very safe drug that promotes improved blood flow to the legs. It usually takes 2-3 months before the effects are apparent
  • Smoke cessation: Extremely important to prevent disease progression
  • Exercise program
  • Weight loss and healthy habits

Endovascular options

  • These are typically performed under sedation and make use of minimally invasive advanced technologies to go inside the arteries and perform a variety of interventions that include:

    • Angioplasty: Inflating a balloon to open up an artery
    • Stenting: Placement of a scaffold to support the artery from the inside
    • Atherectomy: Involves “drilling” through the blockage to restore the lumen

Open surgical options

  • Typically require general anesthesia
  • Endarterecotmy: in which the involved artery is opened up, cleaned out, and usually closed with a patch
  • Bypass surgery: in which a pipe is used to re-route the blood around the blocked segment

Why NTSS?

Our providers are well trained to identify the early signs of PAD and manage them appropriately.

  • We believe in conservative measures prior to proceeding with any intervention
  • We use the most advanced technologies and keep up with new updates in techniques and devices. To list a few:
    • New stents
    • Various atherectomy devices that use rotational, orbital, and directional atherectomy
    • Intra-vascular imaging to properly identify and treat the disease precisely
    • Alternative access points for difficult and non-conventional conditions, including arm access and pedal access
    • Revascularization of the pedal arch
    • Targeting specific anatomical angiosomes to supply flow where it is mostly needed
  • Unlike some other providers who can only perform endovascular procedures, we perform both endovascular and open interventions (and can combine both). This does not limit us to a specific intervention and allows us to tailor the best option for each individual patient.