What is Peripheral Artery Disease (PAD)?

Peripheral artery disease is a condition of the blood vessels that leads to narrowing and hardening of the arteries that supply the limbs. The narrowing of the blood vessels leads to decreased blood flow, which can injure nerves and other tissues.

When you develop peripheral artery disease (PAD), your extremities – usually your legs – don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking.

What are the Causes?

Peripheral artery disease is caused by atherosclerosis, or "hardening of the arteries." This problem occurs when fatty material (plaque) builds up on the walls of your arteries. This causes the arteries to become narrower. The walls of the arteries also become stiffer and cannot widen (dilate) to allow greater blood flow when needed.

As a result, when the muscles of your legs are working harder (such as during exercise or walking) they cannot get enough blood and oxygen. Eventually, there may not be enough blood and oxygen, even when the muscles are resting.

Peripheral artery disease is a common disorder that usually affects men age 50 and older. People are at higher risk if they have a history of:

• High cholesterol
• Diabetes
• Obesity
• Heart disease (coronary artery disease)
• High blood pressure (hypertension)
• Kidney disease involving hemodialysis
• Smoking
• Stroke (cerebrovascular disease)
• Aging
• Family History of peripheral artery disease, heart disease, or stroke

Symptoms and Detection

The classic symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms usually appear during walking or exercise and go away after several minutes of rest.

• At first, these symptoms may appear only when you walk uphill, walk faster, or walk for longer distances.
• Slowly, these symptoms come on more quickly and with less exercise.
• Your legs or feet may feel numb when you are at rest. The legs also may feel cool to the touch, and the skin may look pale.

When peripheral artery disease becomes severe, you may have:

• Erectile dysfunction in men
• Pain and cramps at night
• Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful
• Pain that is worse when you raise your leg and improves when you dangle your legs over the side of the bed
• Skin that looks dark and blue
• Sores that do not heal

Diagnosis begins with:

• A physical exam from your primary physician
• Questions about your medical and family history
• Blood tests to evaluate function & exclude other conditions
• You may need one or more of the following imaging tests for evaluation:
• CT Scan
• Magnetic resonance angiography (MRA)
• Ultrasound
• X-Ray

Treatment

Treatment plans are developed collaboratively by a team of multidisciplinary specialists to ensure the ideal course of action.

• Medical Management – Medical management includes lifestyle changes and medication to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.
• Stenting – In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. Your doctor may also insert a mesh framework called a stent in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.
• Renal Artery Stenting – Renal artery stenting involves the implantation of a metal mesh tube (stent) to hold a clogged artery open to improve blood flow. The stent is put in place through a small, thin tube inserted into an artery in the groin. It is threaded up through the blood vessels to the renal artery (main blood vessel supplying blood to the kidney), and gently expanded, pushing open the blockage and restoring blood flow. Your kidneys need adequate blood flow to help filter waste products and remove excess fluids. Reduced blood flow may increase blood pressure and damage your kidneys.
• Carotid Stenting - An alternative to endarterectomy surgery is a minimally-invasive procedure called carotid stenting.
• Surgical Management – Your doctor may create a graft bypass using a vessel from another part of your body or blood vessel made of synthetic fabric. This allows blood to flow around – or bypass – the blocked or narrowed artery.
• Carotid Endarterectomy – This surgical procedure is the most common treatment for severe carotid artery disease. The procedure is done under either local or general anesthesia. After making an incision along the front of your neck, your surgeon opens the affected carotid artery and removes the plaques.
• Thrombolytic Therapy – If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.

Symptoms and Detection

The classic symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms usually appear during walking or exercise and go away after several minutes of rest.

• At first, these symptoms may appear only when you walk uphill, walk faster, or walk for longer distances.
• Slowly, these symptoms come on more quickly and with less exercise.
• Your legs or feet may feel numb when you are at rest. The legs also may feel cool to the touch, and the skin may look pale.

When peripheral artery disease becomes severe, you may have:

• Erectile dysfunction in men
• Pain and cramps at night
• Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful
• Pain that is worse when you raise your leg and improves when you dangle your legs over the side of the bed
• Skin that looks dark and blue
• Sores that do not heal

Diagnosis begins with:

• A physical exam from your primary physician
• Questions about your medical and family history
• Blood tests to evaluate function & exclude other conditions
• You may need one or more of the following imaging tests for evaluation:
• CT Scan
• Magnetic resonance angiography (MRA)
• Ultrasound
• X-Ray

Treatment

Treatment plans are developed collaboratively by a team of multidisciplinary specialists to ensure the ideal course of action.

• Medical Management – Medical management includes lifestyle changes and medication to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.
• Stenting – In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. Your doctor may also insert a mesh framework called a stent in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.
• Renal Artery Stenting – Renal artery stenting involves the implantation of a metal mesh tube (stent) to hold a clogged artery open to improve blood flow. The stent is put in place through a small, thin tube inserted into an artery in the groin. It is threaded up through the blood vessels to the renal artery (main blood vessel supplying blood to the kidney), and gently expanded, pushing open the blockage and restoring blood flow. Your kidneys need adequate blood flow to help filter waste products and remove excess fluids. Reduced blood flow may increase blood pressure and damage your kidneys.
• Carotid Stenting - An alternative to endarterectomy surgery is a minimally-invasive procedure called carotid stenting.
• Surgical Management – Your doctor may create a graft bypass using a vessel from another part of your body or blood vessel made of synthetic fabric. This allows blood to flow around – or bypass – the blocked or narrowed artery.
• Carotid Endarterectomy – This surgical procedure is the most common treatment for severe carotid artery disease. The procedure is done under either local or general anesthesia. After making an incision along the front of your neck, your surgeon opens the affected carotid artery and removes the plaques.
• Thrombolytic Therapy – If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.