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Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is also known as hardening of the arteries or atherosclerosis. The buildup of fatty plaque causes narrowing of the blood vessels in the legs. 12 million Americans suffer from PAD. It may be present without any signs, symptoms or as discomfort while walking that is relieved by rest. PAD is often undiagnosed. This is dangerous because it can lead to painful symptoms, non-healing ulcers, gangrene and loss of a leg. Individuals with PAD also are at increased risk for heart attack and stroke.

blood flow through the legs

Signs:

The pain of PAD is caused by blockage due to plaque buildup that prevents the muscles from receiving enough blood during exercise to meet their needs. The pain usually goes away after a few minutes when you stop exercising. This is called “intermittent claudication.” The term comes from the Latin word meaning, “to limp.”

Some symptoms to keep in are the following:

  • Pain during walking, which is relieved by resting 
  • Constant leg pain at rest, especially at night or when legs are elevated and usually relieved by hanging the legs down
  • Cold legs 
  • Tingling, burning or loss of sensation 
  • Poor wound healing 
  • Gangrene

Risk Factors for Peripheral Arterial Disease:

  • Hypertension
  • Cigarette Smoking
  • Diabetes
  • Heart disease
  • High cholesterol
  • Obesity
  • Lack of exercise
  • Family history
  • Age
  • Excessive alcohol use
  • Poor nutrition

How is PAD Diagnosed?

Pad is diagnosed in several ways, the first of which is a physical examination to check for weak pulses in the legs.  Other non-invasive vascular examinations include:

  • Ankle-brachial index (ABI) test: If abnormal, you may need further testing
  • Arterial Segmental Pressures: can reveal the level of blockage 
  • Duplex imaging: visualizes the artery, measures the blood flow and indicates the presence of a blockage using sound waves
  • Computed Tomographic Angiography (CT): with use of contrast, it allows imaging (even in 3 dimensional) of the arteries in abdomen, pelvis and legs
  • Magnetic Resonance Angiography (MRA): gives information similar to that of a CT without the use of X-rays
  • Angiography: injecting a contrast agent into the artery, X-rays are taken to show arteries of the legs and any blockages, but it is usually reserved for use in conjunction with treatment (angioplasty or bypass surgery)

How is PAD Treated?

Treatment for PAD consists of preventing progression of the disease and reduction of symptoms. Many patients can be helped by lifestyle changes, exercise and medications, which may slow the progression or even reverse the symptoms of PAD.

Exercise

Regular exercise is the most effective treatment for PAD. A gradual program of supervised exercise training is most often recommended. You begin slowly, walking and rest in intervals, in order to gradually increase the amount of time you can walk before the pain sets in. It is best if this exercise program is undertaken in a supervised setting on a treadmill.

Diet

There is a need to maintain the proper cholesterol levels. Elevated cholesterol levels are common in many PAD patients. A diet low in saturated fat and cholesterol can help lower blood cholesterol levels, but medication may be necessary.

Smoking Cessation

Smoking greatly increases the risk for PAD, heart attack and stroke. Stop smoking. It will help to slow the progression of PAD and other heart-related diseases.

Medication

Medications include cilostazol and pentoxifylline may help improve the distance you can walk. Additionally, antiplatelet medications (aspirin and clopidogrel) or anticoagulation medication (warfarin) help to prevent blood clots.

Procedures

Minimally invasive procedures consist of balloon angioplasty, stent placement (tiny wire mesh cylinder to help hold the artery open), and clot-removal or plaque removal treatment. They are non-surgical and are performed by our surgeons through a small puncture site, in which a catheter is inserted to reach the blocked artery.

If minimally invasive method is not successful or not indicated due to extensive blockage, a surgical procedure may be necessary. A vein from the patient or a synthetic graft is used to “bypass” and reroute blood around the blocked artery. We will discuss your options and help guide you to choose the best procedure for your individual situation.

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