Peripheral Arterial Disease
What is peripheral arterial disease (PAD)? PAD is a condition in which the
arteries become narrowed by plaque limiting the blood flow to the limbs, sometimes
becoming completely blocked.
Normal Arterial Blood Flow Plaque Formation
IMPORTANT FACTS ABOUT PAD:
8-12 million in the United States have PAD. It is common, but often under-
recognized. As many as 20-30 million people may be at risk.
If you have PAD, you are 5 times more likely to have a heart attack.
WHAT ARE THE SYMPTOMS OF PAD?
Claudication - Pain, aching or fatigue in the calf, thigh or buttock
occurring after walking; consistently relieved with rest. If
claudication progresses to rest pain, may indicate severe
Cool temperature of the leg or foot
Loss of hair on lower legs and feet
Slow healing ulcers on legs and feet
Reddish-blue color of the leg when sitting
WHAT ARE THE RISK FACTORS FOR PAD?
Coronary artery disease
High blood pressure
Family history of peripheral arterial disease
HOW IS PAD DIAGNOSED?
Ankle-brachial Index (ABI): This is a painless test that
measures and compares the blood pressure in the arms
and ankles. If there is difference between the results,
results are read as abnormal. If abnormal, more tests may
be needed to check for blockages.
CT angiogram: Contrast dye is given through an IV in
your arm. You lay under the camera and images are taken
of the blood vessels. The contrast dye highlights the blood
Ultrasound: A painless test in which a probe is moved up
and down the skin over the blood vessels. Sound waves
reflect off blood cells as they flow through the blood vessel to form a picture.
Magnetic Resonance Angiography: A non-invasive test in which you lay under a
camera and pictures are taken. Powerful magnets are used to create a field to
examine blood flow through the blood vessels.
Arteriogram: Invasive test in which a plastic tube is inserted usually into an artery
in the groin area. Contrast (dye) is injected into the artery and a type of x-ray takes
pictures of the flow within the blood vessels. Considered the gold standard of
checking for blockages.
HOW IS PERIPHERAL ARTERIAL DISEASE TREATED?
Modify risk factors such as smoking cessation, blood pressure control, weight loss,
lowered cholesterol level, and blood sugar control.
Exercise - Increase your walking. This helps build collaterals (formation of new
small vessels to help supply oxygen to the muscle). Also, conditions the leg
muscles to work with less oxygen.
Medicines - Medicines are used to lower blood pressure, lower cholesterol, and to
lower blood sugar. Others help prevent blood from
Angioplasty/Stenting or Atherectomy – In this
procedure a tube is fed through your artery and
dye is injected to see your vessels. Your femoral
artery in the groin is usually the site of insertion,
although the brachial artery in the arms and popliteal artery behind the knee can
also be used. If a blockage is detected, treatments include balloon inflation to open
the blockage, implantation of a stent or eliminating the blockage by shaving the
plaque and removing it in a catheter.
Surgical revascularization (Bypass) - Surgery where blood flow is re-established
using a vein taken from the patient’s leg or a synthetic one that is connected to the
artery above and below the blockage.
OTHER TYPES OF VASCULAR DISEASE:
Carotid Artery Disease - Plaque builds up in main artery to the brain. If this occurs,
you are at a higher risk for having a stroke. Many times with this disease a TIA can
occur (transient ischemic attack, also known as a “mini-stroke”).
Symptoms: Confusion, weakness, slurred speech,
paralysis, headache, loss of balance, blurred vision.
1) Controlling risk factors
2) Carotid balloon angioplasty/stenting
3) Carotid endarterectomy (surgical repair)
Renal Artery Disease - Plaque builds up in arteries to the kidneys. If it occurs, your
kidneys may not work as efficiently and
may cause high blood pressure.
1) Control risk factors
2) Renal balloon angioplasty/stenting
Abdominal Aortic Aneurysm - A ballooning of the major artery in your abdomen
area occurring at a weak spot. Blood enters into the wall of the vessel and builds
pressure causing stretching of the vessel. If pressure is too great, the size of the
aneurysm will increase and may rupture, which can be life-threatening.
Symptoms: Most commonly none
1) Repair with stenting
2) Abdominal aortic surgery repair
References for additional information:
http://www.americanhart.org/ Click on diseases/conditions
http://www.vdf.org Click on disease information