Peripheral Artery Disease (PAD) is caused by blockage from plaque buildup in your arteries that supply oxygenated blood to your legs and arms.  When you develop PAD, your extremities, usually your legs, don’t receive enough blood flow to keep up with demand. PAD is commonly a sign of a more widespread accumulation of fatty deposits in your arteries known as atherosclerosis, which reduces blood flow to your heart and brain as well as your legs.

Less common causes of peripheral arterial disease (PAD) include:

• Blood vessel inflammation
• Injury to the arms or legs
• Changes in the muscles or ligaments
• Radiation exposure

COMMON PAD SYMPTOMS

Although many people with peripheral arterial disease have no symptoms, many have leg pain while walking, a condition called claudication. These symptoms include muscle pain or cramping in the legs or arms triggered by activity but disappear after a few minutes of rest. The location of the pain depends on the location of the narrowed or blocked arteries. Pain in the calf muscles of an affected limb is the most common. Severity also varies widely, from mild discomfort to debilitating pain. Severe claudication symptoms can make walking or performing other physical activities difficult.

Other PAD symptoms can include:

• Leg numbness or weakness
• Coldness in the lower leg or foot, especially when compared with the other side
• Sores on the toes, legs or feet that won’t heal, called critical limb ischemia, causing tissue to die
• A change in the color of your legs
• Hair loss or slower hair growth on the feet and legs
• Slower toenail growth
• Shiny skin on the legs
• No pulse or a weak pulse in the legs and feet
• Erectile dysfunction in men

When peripheral arterial disease progresses, pain may happen when you’re resting or lying down. It may also be intense enough to disrupt sleep. Hanging your legs over the edge of the bed or walking around the room may temporarily relieve pain.

WHO NEEDS PAD SCREENING

Unfortunately, many people ignore the symptoms, placing themselves at risk. Even if you don’t have symptoms, the professionals at VIVAA may recommend screening if you have one or more risk factors. You are at increased risk of PAD increases as you get older.

We may recommend screening if you fall into one of the following risk factors for PAD:

• Over age 70
• Over age 50 and have a history of diabetes or smoking
• Under age 50 and have diabetes, are obese, have high blood pressure or high cholesterol

WHAT HAPPENS IF PAD IS NOT TREATED

Patients with PAD have a higher risk of coronary artery disease, heart disease, or stroke. When left untreated, this condition can lead to the development of gangrene in a limb, as well as amputation.

DIAGNOSIS

Fortunately, PAD is easy to diagnose. At VIVAA, we use several technologies to diagnose poor blood flow to determine if you are suffering from PAD. A physical exam is the first step. Dr. Sidhu may find a weak or absent pulse below an artery narrowed by plaque. A stethoscope may detect whooshing sounds over these arteries, while evidence of poor wound healing in the area where blood flow is restricted may be present. Poor circulation in the affected limbs is another sign.

Other tests to diagnose the condition can include:

• Ankle-brachial index (ABI) is a common test used to diagnose PAD. Your doctor uses a regular blood pressure cuff on the ankle and arm for medical evaluation. To properly determine severe PAD, we may be required to walk on a treadmill before and after blood pressure readings are taken.
• Dr. Sidhu commonly uses ultrasound to diagnose reduced blood flow in peripheral arterial disease. In this test, the ultrasound technologist can scan blood vessels and actually see the fatty plaque and degree of blockage. This test helps Dr. Sidhu evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
• Angiography utilizes a contrasting dye inserted into blood vessels, allowing VIVAA surgeons to track blood flow through your arteries as it happens through imaging techniques such as X-rays, magnetic resonance angiography (MRA) or computerized tomography angiography (CTA).
• Catheter angiography is more invasive as it involves guiding a catheter through an artery in your groin to the affected area and injecting dye through that. Although invasive, this type allows for simultaneous diagnosis and treatment by finding the narrowed area of a blood vessel and then widening it with a dilating procedure or administering medication to improve blood flow.
• Blood tests to determine if you have high blood cholesterol and triglycerides and to check for diabetes.

TREATMENT

Peripheral artery disease is easy to treat. Patients can take control by making healthy lifestyle changes and following Dr. Sidhu’s recommendations. For less severe cases, lifestyle changes and medication are all needed. If you are someone who uses tobacco, quitting is the single most important thing you can do, as smoking increases the chance of plaque buildup in your arteries and contributes to high blood pressure.

Treatment has two major goals: to manage symptoms so you can resume physical activity and to stop the progression of atherosclerosis throughout your body to reduce the risk of heart attack and stroke. Lifestyle changes can sometimes accomplish these goals. If you are someone who smokes, quitting is the single most important thing you can do.

If you have severe PAD, lifestyle modifications may not be enough. When lifestyle modifications are not enough, then intervention is needed. You may need to take aspirin or other anti-platelet medications. We may recommend supervised exercise training to increase blood flow to arteries and reduce leg pain. These days, most interventions are minimally invasive endovascular procedures involving an angiogram, atherectomy, angioplasty, and/or stenting, depending on the blockage and location.

Angioplasty widens the artery via a catheter with a small balloon. The balloon is slid into place at the blockage and inflated to break the fatty plaque and let blood flow normally. A stent is slid into place to keep the artery open. The stent may have medicine on it to prevent further blockage.

An atherectomy is another modality that helps treat blockages in arteries. An atherectomy catheter has a sharp blade on the end that scrapes plaque from artery walls and then collects it for removal.

All endovascular procedures are outpatient, and most patients can resume their normal activity level the next day.