St. Joseph Hospital of Orange
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Peripheral Artery Disease (PAD)

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.

Risk Factors

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 the arterial narrowings 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 Center for Heart and Vascular Wellness and Prevention at St. Jospeh Hospital offers simple, low-cost screenings for the early detection of PAD. To schedule a screening please call (714) 633-DOCS (3627). For additional heart and vascular screening information please click here.

Treatment

Depending on your overall health and the extent of PAD, the experts at the St. Joseph Hospital Heart and Vascular Center may recommend a variety of conservative treatment options, including smoking cessation, control of high blood pressure or cholesterol, taking good care of your feet and following a daily walking program. If the arterial blockages increase in number or severity this may result in disabling claudication (calf pain) symptoms or limb-threatening ischemia. More aggressive treatment options may be recommended. These options may range from less invasive techniques such as balloon angioplasty, stent placement or atherectomy (removing plaque using a small catheter) to surgical bypass that essentially re-routes blood around the affected area.

The vascular specialists at St. Joseph Hospital offer the latest in minimally invasive and open surgical techniques to treat the following conditions related to PAD:

  • Upper extremity atherosclerosis
    • Activity-induced arm pain or chronic fatigue
    • Non-healing finger ulcers
    • Subclavian Steal Syndrome
  • Lower extremity issues
    • Leg pain with walking (claudication)
    • Foot pain at rest
    • Non-healing foot ulcers
    • Gangrene
  • Vasculitis
    • Non-healing, painful finger ulcers
  • Takayasu's (pulseless) disease
  • Arterial embolism and thrombosis
  • Blue-toe syndrome