PAD is the development of blockages made up of cholesterol, fat, and calcium in the arteries of the legs. Smoking, high blood pressure, high cholesterol, diabetes, kidney failure, and obesity increase your risk for developin PAD. These blockages can limit blood flow to the legs and feet causing pain, cramping, or weakness in the legs and feet when walking. This is called claudication. If the blockages get worse and become more severe it can sometimes lead to the development of constant and relentless pain of the legs and feet. Sores, ulcers, and even gangrene of the feet . This can ultimately lead to leg amputation. This is absolutely what we want to prevent.
Early identification of peripheral arterial disease is required in order to prevent amputation. Most times when we identify this disease process early (during the claudication phase) we can use balloons and stents to open up blockages in the arteries of the legs. These procedures restore blood flow to the legs, can be done through catheters, and do not require incisions. Most times these procedures can be performed in our office interventional suite and do not require a visit to the hospital. When blockages of the arteries and the legs are more extensive then more invasive bypass surgery may be required in order to restore blood flow to the legs. These procedures requires incisions to be made on legs and hospitalizations for 2 to 5 days.
After treatment of peripheral arterial disease with either balloons and stents or bypass surgery, patients typically follow up in the office between two and three weeks after the procedure. If there are no problems at this point then patients are allowed to resume work and their normal activities as tolerated PAD is a chronic disease in which plaque builds up in the arteries of the legs. This buildup typically occurs gradually. If allowed to progress, blood flow in that artery can become limited or blocked all together. PAD is relatively common, affecting more than 10 million people in the U.S. It is more common in people who are 65 or older, but can occur at nearly any age. Smoking, high blood pressure, high cholesterol, diabetes, kidney failure, and obesity increase your risk for PAD.
Symptoms
Fatigue or cramping of your muscles (claudication) in the calf, thigh, hip, or buttock may signal you have PAD. Typically the discomfort is felt after walking a certain distance and goes away with rest.
- If you have pain in your toes or feet while resting, you may have an advancing case of PAD.
- An open wound or ulcer on your toes or feet, often at a pressure point on the foot, can signal a serious case of PAD. An ulcer can progress to gangrene. These symptoms require immediate medical attention.
Diagnosis
- An initial diagnostic test for PAD is the ankle brachial index (ABI). The test involves taking a blood pressure reading at the ankle and comparing it to that in the arm.
- An ultrasound is often obtained to determine the location and severity of blockages.
- A special CT scan to evaluate the arteries may be needed after you are seen by the vascular surgeon.
Treatments
PAD is usually treated by managing the risk factors with lifestyle changes and medication. This includes quitting smoking, controlling blood pressure and cholesterol, controlling diabetes, and losing weight. In addition, an exercise program, if followed faithfully, can significantly improve the symptoms of PAD in many cases. If PAD is causing serious symptoms, further treatments such as balloon angioplasty, stent placement, or surgical bypass can be very effective in improving the blood flow to the affected leg.