In contrast to vein disease of the legs—which is a dilation of the veins—Peripheral Arterial Disease (PAD) is a narrowing of the arteries. This narrowing of the arteries is secondary to plaque buildup. 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 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. Another sign that blood flow may be seriously compromised is when your feet or toes are discolored or if wounds have developed on your leg spontaneously.
Beyond claudication and exertional leg pain, PAD has a variety of other symptoms:
Some PAD symptoms (like blue toes and cold feet) overlap with symptoms of Raynaud phenomenon, also known as Raynaud’s disease. However, the symptoms of Raynaud phenomenon are brought on by constant cold temperatures or emotional distress and are relieved by increasing circulation and warming the extremities. PAD symptoms, on the other hand, tend to be brought on by exertion and can typically only be alleviated by resting.
PAD is caused by plaque build-up in the arteries of the legs called atherosclerosis. In atherosclerosis, the plaque in your arteries hardens on the walls of your arteries. The hardening of the arteries leads to poor circulation in your legs. This process is similar to what occurs in the arteries of the heart with a heart attack and coronary artery disease. Other medical conditions that may present similarly to PAD include peripheral neuropathy, spinal stenosis, blood clots in the deep veins, and other musculoskeletal conditions.
The most common risk factors for PAD are similar to that of coronary artery disease (CAD), also known as carotid artery disease, and include:
Two basic noninvasive tests are used to screen and identify PAD, including ABI (ankle-brachial-index) and peripheral arterial Doppler ultrasound (peripheral artery sonogram), which are both performed 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.
A peripheral angiogram is invasive diagnostic imaging to determine the locations and degree of narrowed arteries. This procedure will be completed in the hospital by Dr. Zachary George from our office. Dr. George has over 15 years of experience performing these cases. The procedure involves contrast and live imaging to determine specific locations and the degree of stenosis and what needs to be fixed.
Depending on the severity of symptoms and results from diagnostic testing, a regular walking routine and medications may be enough to improve your PAD symptoms. If the disease is more advanced, intervention is required to remove the obstruction. The removal of plaque or obstruction is completed at the time of the peripheral angiogram with atherectomy (roto-rooter), balloon angioplasty, and/or stent placement.
Atherectomy
A minimally invasive technique, atherectomy removes plaque in the arteries (atherosclerosis) using a catheter with a small rotating blade on the end. Once the plaque is removed, the artery is wider, improving blood flow. This procedure is performed under local anesthesia and may be used in conjunction with balloon angioplasty.
Balloon Angioplasty
A specialized catheter with a small balloon is cautiously guided through the artery to the site of blockage or narrowing, then the balloon is inflated to widen the opening and increase blood flow to the area. A stent is often placed during this procedure to keep the artery open after the balloon is deflated and removed.
Stent Placement
If the plaque blockages are significant and are located above the knees, we may use stents to help keep your artery open. A stent is a small wire tube, which when placed remains expanded inside your artery, reopening blood flow to the area.
Bypass Surgery
If no intervention can be done because of complete occlusions that cannot be opened up, bypass surgery performed by a vascular surgeon is the last option to prevent amputation.
Heart of Dixie Vein and Vascular Center specializes in not only the treatment of PAD but also aggressively helps you prevent PAD and diseases of the heart. We will help you and counsel you on the following to help you prevent peripheral vascular diseases like PAD:
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