Peripheral Arterial Disease (PAD)
What is peripheral arterial disease (PAD)?
Peripheral arterial disease is a group of diseases affecting the blood vessels – or arteries – that supply blood and oxygen to the legs. The most common cause of PAD by far is plaque, a buildup of cholesterol and fat in the walls of the arteries that narrows their inner diameter. Most often PAD affects the larger arteries in the pelvis and thighs, but sometimes it affects the smaller vessels in the lower legs and feet, especially in diabetics. The main risk factors for PAD include smoking, an unhealthy diet, diabetes and high cholesterol.
What are the symptoms of PAD?
Usually the damage to the arteries caused by PAD is silent, but often the disease progresses to the point that symptoms can occur. The mildest symptoms are called "claudication": cramping in the legs, thighs or buttocks that comes on with exercise or walking, and is relieved by rest. More severe symptoms include pain in the feet at rest and ulcers and sores on the feet that will not heal. Occasionally a plaque can cause a sudden complete blockage, which usually produces severe symptoms.
What are the long-term consequences of PAD?
Many times PAD can progress slowly, but if left untreated PAD can progress to the point of debilitating pain, and leave the feet at risk of skin breakdown and infection. Because of this, PAD is a major cause of leg and foot amputations in this country. And because PAD usually coexists with plaque in the arteries of the brain and heart, many people with PAD will suffer heart attacks or stokes.
How is PAD diagnosed?
A simple test called an ankle-brachial index is a good screening tool for detecting PAD that can be done in your doctor’s office. Your doctor might order slightly more complicated test using blood pressure cuffs and ultrasound to test for PAD noninvasively. Two non-invasive tests that can visualize the arteries directly are CT angiography and MRI angiography. These tests both require an IV injection of contrast material during the examination. An angiogram is the traditional invasive test used to visualize diseased arteries.
What is an angiogram?
An angiogram is a simple and common test that has been used for over 50 years to diagnose vascular disease. To perform an angiogram, your doctor inserts a thin hollow tube, called an "angiographic catheter" into the artery in the groin. Liquid contrast material, or "X-ray dye" is injected through the catheter and X-ray images are taken while the dye flows through the arteries down the legs. The procedure is done awake with local anesthesia to numb the groin, and IV medication is given to reduce anxiety. After the angiogram, pressure is applied for a few minutes to seal up the tiny hole in the artery, and you can usually be sent home after a few hours.
What are the treatment options for PAD?
The most important treatment for PAD is prevention. To prevent the progression of PAD patients should quit smoking, eat a healthy diet and exercise. Often claudication will significantly improve with lifestyle modification and exercise alone. Medical treatments, which have been shown to work along with a healthy lifestyle, include a daily platelet inhibitor such as aspirin and a cholesterol-lowering drug such as Lipitor. Patients may also benefit from appropriate treatment of high blood pressure. Because these treatments are also good for your brain and heart, the medical and lifestyle treatments given for PAD can also prevent heart attacks and stroke.
Are there procedures that can help improve the symptoms of PAD?
If symptoms are severe enough that medical and lifestyle treatments alone are insufficient, there are many options for the treatment of PAD. Open surgery was the traditional way that PAD was treated, but interventional radiologists pioneered non-surgical treatments that have become the first line invasive therapy in many situations. Interventional treatments include angioplasty, stent placement, atherectomy, and cryoplasty.
What is an angioplasty?
An interventional radiologist named Dr. Charles Dotter pioneered the technique of transluminal angioplasty over forty years ago. The methods and technology used during an angioplasty have been refined over time, but the basic technique is unchanged. A balloon mounted on the end of a catheter is guided through the blood vessel and across the point of blockage using imaging guidance. The balloon is inflated and the vessel is stretched open. Occasionally a stent, a kind of tubular metal scaffold, is needed to prevent elastic rebound and keep the vessel wide open. After the vessel is opened, the catheter is removed. Recovery is similar to simple angiography, described above.
What other image-guided procedures are available to treat PAD?
Because angioplasty and stent placement are not always optimal to treat complex PAD, numerous other technologies have been developed over the years. Some technologies have come and gone, others are currently in use, and many more promising treatments are in development. Those currently offered by Utah Vascular Clinic are listed here:
Cryoplasty: an angioplasty balloon that chills the inner lining of the blood vessel to help prevent recurrent buildup, or "restenosis".
Percutaneous atherectomy: a catheter with a rotating blade is used to shave off the plaque and remove it from the body.
Stent grafts: stents covered with a thin fabric are used to line the artery.
More information:
The Society of Interventional Radiology is a good resource for information about PAD www.sirweb.org. For a consultation with an interventional radiologist at Utah Vascular Clinic, call 801-281-0027 to schedule an appointment.