Peripheral Arterial Disease (PAD)
In contrast to vein disease of the legs- which is a dilatation of the veins– Peripheral Arterial Disease (PAD) is a narrowing of the arteries. This narrowing of the arteries is secondary to plaque build up. As these vessels narrow the muscles of the legs don’t get the necessary blood flow or oxygen, thus causing pain to the legs. This pain is made worse with exercise and is called claudication.
Intermittent Claudication:
Intermittent claudication is a term used to describe muscle pain (ache, cramp, burning, numbness or sense of fatigue), in the legs that occurs during exercise and is usually relieved by a short period of rest. It is most commonly felt in the calf muscles, but can occur in your feet, thighs, hips, or buttocks. Other signs that blood flow may be seriously compromised are when there is a bluish or black discoloration with your toes or feet or having sores on your toes, feet, heels, or other locations on your legs that are slow to heal or do not heal at all.
Causes of PAD:
PAD is caused by plaque build up in the arteries of the legs. This is a similar process that occurs in the arteries of the heart with a heart attack and coronary artery disease. There are other problems that can cause similar symptoms and include peripheral neuropathy, spinal stenosis, clots in the deep veins, and other musculoskeletal conditions.
Risk Factors:
The most common risk factors for PAD are similar to that of coronary artery disease (CAD) and include:
- Smoking
- High cholesterol
- High blood pressure
- Obesity (a body mass index over 30)
- Diabetes
- Age older than 70 years
- A family history of atherosclerosis, peripheral artery disease
Diagnostic Tests:
Two basic noninvasive tests are used to screen and identify PAD including ABI (ankle-brachial-index) and peripheral arterial doppler ultrasound that are done at Heart of Dixie Vein and Vascular Center. The ABI compares blood pressure measurements in the ankles to the blood pressure in your arms and comes up with an index to tell us the likelihood of having obstructive blood flow through the arteries of the legs. The peripheral ultrasound visualizes the arteries and provides blood flow visualization with numbers to assist in determining if there is a blockage.
The invasive diagnostic imaging to determine the locations and degree of narrowed arteries is a peripheral angiogram. This is done in the hospital with an interventional cardiologist specially trained for this procedure. It involves contrast and imaging to determine specific locations and degree of stenosis and what needs to be fixed.
Treatment Options:
Depending on the severity of symptoms and results from diagnostic testing, a regular walking routine and medications may be enough to improve symptoms. but usually intervention is required to remove the obstruction. This is completed at the time of the peripheral angiogram with atherectomy (roto-rooter) and drug coated balloon angioplasty. If the blockages are above the knee, stents may be used. If no intervention can be done because of complete occlusions that cannot be opened up, vascular surgery with bypasses is a last option to prevent amputation.
Prevention:
Heart of Dixie Vein and Vascular Center specializes in not only the treatment of PAD but will aggressively help you prevent PAD and diseases of the Heart. We will help you and council you on the following to help you prevent vascular disease:
- Cholesterol and blood pressure management through lifestyle changes and medications when necessary.
- Diabetes management
- Weight loss
- Smoking cessation
- Regular exercise (5 days a week minimum)
- Mediterranean Diet