Heart and Vascular Center
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.
The following risk factors are associated with PAD:
- Age 50 years or older
- High cholesterol
- High blood pressure
- Physical inactivity
- A family history of heart disease or PAD
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
- 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
If the 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.
Depending on your overall health and the extent of PAD, the experts at
St. Mary Medical 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. Mary Medical Center 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
- Non-healing, painful finger ulcers
- Takayasu's (pulseless) disease
- Arterial embolism and thrombosis
- Blue-toe syndrome