Peripheral Artery Disease (PAD)
Peripheral Arterial Disease (P.A.D) exists when the arteries in the legs become narrowed or clogged with fatty deposits, or plaque. The buildup of this plaque is called atherosclerosis or more commonly referred to as clogged arteries. When the leg arteries become clogged and hardened, the blood flow to the legs and feet is reduced. This reduction of blood flow can cause pain, changes in skin color, sores or ulcers of the feet and legs, and difficulty walking.
This condition occurs most often in the leg arteries, but it can also affect other arteries. It sometimes affects the arteries going to the arms, kidneys and stomach. When it affects the heart and coronary arteries, it is called Coronary Artery Disease. The good news is that like other diseases related to the arteries; P.A.D. can be treated by making lifestyle changes, taking medications, or undergoing leg artery angioplasty or surgery, if needed.
There are many tests that can be performed when diagnosing P.A.D. Usually physicians start with the least invasive tests and will perform more invasive tests as symptoms progress. Your primary physician can start the diagnostics with a simple test called an A.B.I. or ankle brachial index. This painless exam compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. The ankle pressure is at least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent. If the A.B.I is abnormal, you may expect one or several of the following tests which are still fairly simple tests:
Doppler and Ultrasound (Duplex) Imaging: a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents, when magnetic tests can not be used.
Magnetic Resonance Angiography (MRA): a non-invasive test that uses a magnetic field, radio waves and a computer to produce images of the soft tissue involved in the affected area. It does not use traditional ionizing radiation.
After a diagnosis has been made, if the blockage is not severe, several lifestyle changes or medication therapies may be tried. Of course the most common modifications are ones that most of us have heard over and over.
Lifestyle and Medication changes
Smoking cessation: Tobacco smoke greatly increases your risk for PAD and your risk for heart attack and stroke. Smokers may have four times the risk of developing PAD than nonsmokers. By eliminating smoking it will help to slow the progression of PAD.
Diet modification: Many PAD patients have elevated cholesterol levels. A diet low in saturated fat, trans fat and cholesterol can help lower blood cholesterol levels, but medication may also be necessary to maintain the proper cholesterol levels.
Exercise: Regular physical activity is a very effective treatment in early PAD. You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs three times a week can result in decreased symptoms in just four to eight weeks.
Medication: You may be prescribed medication for blood pressure control, and cholesterol lowering. It is important to take these medications regularly and as prescribed by your physician. You may also be prescribed medications such as Pletal that will allow you to walk easier with less claudication. In addition, medications such as Aspirin and Plavix are widely used to keep platelets in the blood from sticking together and forming clots. Medications vary greatly from patient to patient and what someone else takes may not be the best medication for you. Follow your doctor’s instructions and his plan for your rehabilitation.
Minimally Invasive Treatment
For some patients the above recommendations and treatments aren't enough, and minimally invasive treatment or surgery may be needed. Minimally invasive procedures consist of angioplasty or stent placement (as is done in the heart for CAD) or clot-removal treatment. They are nonsurgical and are performed by making a small incision, usually in the groin, through which a catheter is inserted to reach the blocked artery. A tiny balloon is inflated inside the artery to open the clog.
A stent — a tiny wire mesh cylinder — may also be implanted at this time to help hold the artery open. Sometimes it will take more than one of these procedures to open up all of the areas that are blocked.
If the angiogram is performed and there's a long portion of artery in your leg that's completely blocked and you're having severe symptoms, surgery may be necessary. Your doctor will meet with you to explain what will be planned for you.
Peripheral Bypass Surgery is a procedure that uses a graft to reroute blood around a blockage in a peripheral artery. This graft bypasses the narrowed or blocked area restoring blood flow. The grafts can come from your own veins, arteries, or a synthetic graft of manmade materials. Usually you will spend approximately 3 – 4 days in the hospital during which time you are able to get up and get around on your own.