Heart and Vascular Center

Peripheral Artery Disease

Peripheral arterial disease (PAD) is a term that is commonly used to describe vascular disease affecting arterial blood vessels of the lower extremities. It is a chronic inflammatory condition in the walls of arteries, in large part due to deposits of lipoproteins (plasma proteins that carry cholesterol and triglycerides). It is often referred to as a "hardening" of the arteries or atherosclerosis and is heralded by ischemic symptoms caused by a narrowing or blockage in the arteries.

Mention blocked arteries and most people think of the heart. However, these blockages can affect other areas of your body, especially blood vessels in the abdomen, kidneys, legs, neck and brain. Atherosclerosis can lead to a range of serious health problems, including high blood pressure, crippling leg pain, heart attack, stroke, aneurysms and even kidney failure. Millions of Americans over the age of 50 have PAD and the prevalence of this condition increases as people age.

The following risk factors are associated with PAD:

  • Age 50 years or older
  • Diabetes
  • Smoking
  • High cholesterol
  • High blood pressure
  • Obesity
  • Physical inactivity
  • A family history of heart disease or PAD

PAD Symptoms

When a blood vessel is clogged, smaller blood vessels try to compensate by rerouting blood around the clog. This will eventually fail, however, because these "detours" simply cannot carry as much blood as the larger blood vessel. Starved of oxygen-rich blood, the muscles almost literally cry out in pain. Symptoms of PAD include:

  • Calf pain (e.g., claudication) - usually starts after a period of walking and is relieved by a short period of rest
  • Thigh or buttock pain – occurs when the arterial blockages are present above the groin level in addition to the mid-thigh level, which is typically associated with calf pain as described above
  • Impotence
  • Feet that are cold to the touch, with toes that may appear discolored or bluish when dangling
  • Weak or absent pulse in the lower extremities
  • Limb-threatening Ischemia

If arterial narrowing or blockages increase in number and severity then the following can occur: rest pain (pain in the forefoot at night that wakes one up from sleep), non-healing ulcers or gangrene, usually at the foot level. Although not as common as claudication, severe complications can result when the lower extremities are continuously starved of oxygen-rich blood. If left untreated, limb-threatening ischemia can lead to the amputation of the toes or feet. Screening is therefore important to identify patients with PAD before the occurrence of more serious complications.

PAD Screening and Diagnosis

Diagnosis is made by taking your medical history and performing diagnostic tests to determine how well blood flows through your vessels. The St. Joseph Hospital Vascular Institute offers simple, low-cost screenings for the early detection of PAD. To schedule a screening please call 1-877-VASC123 (1-877-827-2123).

Treatment

The most common complaint of people with PAD is “claudication”. Claudication is pain in the calf or thigh muscle that occurs after you have walked a certain distance. The pain stops after rest. Claudication occurs because not enough blood is flowing to the muscle. Physicians may order a test to check the blood flow to the leg. This can be done by using an ultrasound scan called a Doppler study and is usually performed in the outpatient area of the Vascular Institute. If surgery or a lesser invasive treatment by the Interventional Radiologist might help treat the symptoms of claudication, an angiogram will be recommended. This is an x-ray taken after dye is injected into an artery. The dye study may show narrowing in the artery and provide a map for the surgeon who will do the surgery or for the Interventional Radiologist who will do an angioplasty and possibly a stent to keep the narrowed area open. Angioplasty is the process of opening up the narrowed artery by placing a thin tube, called a catheter, into the narrowed artery. A stent is a small wire mesh tube that is left in the artery after the angioplasty catheter is removed. Angioplasty and stent placement is done in the Interventional Radiology department, using intravenous medication to make our patients “sleepy and relaxed”. Typical recovery for the procedure is less than 24 hours, usually allowing patients to return home six hours after their procedure.

Outcomes

Although angioplasty and stenting for the treatment of PAD opens up arteries and keeps the blood flowing, it does not stop plaque from building up. Patients are encouraged to consider lifestyle changes to decrease the risk factors contributing to atherosclerosis and to have follow-up by their primary physicians and /or Vascular Institute physician if symptoms reoccur. This includes diet control, regular exercise, maintaining ideal body weight, smoking cessation and recommendations to control cholesterol levels and/or blood sugar levels for diabetic patients.