Peripheral Arterial Disease

What is it?

Peripheral Arterial Disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of PAD is atherosclerosis. This happens when plaque, a substance made up of fat and cholesterol, builds up on the walls of the arteries that supply blood to the arms and legs. The plaque causes the arteries to narrow or become blocked. This can reduce or stop blood flow, usually to the legs, causing them to hurt or feel numb. If severe enough, blocked blood flow can cause tissue death. If this condition is left untreated, a foot or leg may need to be amputated.

atherosclerosis

Symptoms

  • Claudication (pain, weakness, numbness or cramping in muscles due to decreased blood flow)
  • Sores, wounds, or ulcers that heal slowly or not at all
  • Noticeable change in color (blueness or paleness)
  • Noticeable change in temperature (coolness) when compared to the other limb
  • Diminished hair and nail growth

Testing

Tests to Measure Blood Flow
  • Ankle-Brachial Index
  • Doppler Ultrasound – This test uses ultrasound to measure blood flow.
Imaging Tests
  • Arteriography
  • CT Arteriography (CTA)
  • MR Arteriography (MRA)

Treatment

The overall goals of treating PAD include reducing symptoms, improving quality of life, and preventing complications. Treatment is based on your signs and symptoms, risk factors, and results from a physical exam and tests.

Lifestyle Changes

Treatment often includes making long-lasting lifestyle changes, such as:

  • Quitting smoking.
  • Lowering blood pressure.
  • Lowering high blood cholesterol.
  • Lowering blood glucose (sugar) levels if you have diabetes.
  • Being physically active.
  • Follow a healthy eating plan that’s low in total fat, saturated fat, trans fat, cholesterol, and sodium (salt).
Medicines

Your doctor may prescribe medicines to:

  • Treat unhealthy cholesterol levels and high blood pressure
  • Prevent blood clots from forming due to low blood flow
  • Help ease leg pain that occurs when you walk or climb stairs
Surgery or Procedures
  • Bypass Grafting
    Your doctor may recommend bypass grafting surgery if blood flow in your limb is blocked or nearly blocked. For this surgery, your doctor uses a blood vessel from another part of your body or a man-made tube to make a graft.

    This graft bypasses (that is, goes around) the blocked part of the artery. The bypass allows blood to flow around the blockage. This surgery doesn’t cure PAD, but it may increase blood flow to the affected limb.

  • Angioplasty and Stenting
    Your doctor may recommend angioplasty to restore blood flow through a narrowed or blocked artery.

    During this procedure, a catheter (thin tube) with a balloon at the tip is inserted into a blocked artery. The balloon is then inflated, which pushes plaque outward against the artery wall. This widens the artery and restores blood flow.

    A stent (a small mesh tube) may be placed in the artery during angioplasty. A stent helps keep the artery open after angioplasty is done. Some stents are coated with medicine to help prevent blockages in the artery.

  • Stent

  • Atherectomy
    Atherectomy is a procedure that removes plaque buildup from an artery. During the procedure, a catheter is used to insert a small cutting device into the blocked artery. The device is used to shave or cut off plaque.
    The bits of plaque are removed from the body through the catheter or washed away in the bloodstream (if they’re small enough).
    Doctors also can do atherectomy using a special laser that dissolves the blockage.

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