Peripheral Arterial Disease

Definition

Peripheral arterial disease (PAD) usually occurs when arteries outside the heart and brain become narrowed or blocked. PAD most often occurs in the arteries of the pelvis and legs. Narrowing or blockages are usually caused by the buildup of plaque in the arteries, creating a condition known as hardening of the arteries (atherosclerosis). Left untreated, serious cases of PAD can lead to loss of circulation in the legs, gangrene and amputation of the affected limb.

Causes

Atherosclerosis is the most common cause of PAD.

Risk

• High levels of triglycerides (more than 200 mg/dL) and "bad" (LDL) cholesterol (more than 160 mg/dL)
• Smoking and exposure to tobacco smoke
• High blood pressure (greater than 140 mmHg systolic pressure or 90 mmHg diastolic pressure)
• Diabetes
• Inactivity
  

Symptoms

• Leg pain that stops when exercising ends
• Toe or foot wounds that don't heal or are slow to heal
• Gangrene
• A significant temperature decrease in the lower leg or foot compared with the rest of the body
  

Diagnosis

• Ankle-brachial index (ABI): The ABI test compares the blood pressure in the foot to the blood pressure in the arms to see how well blood is circulating in the legs. A difference in blood pressure of 10 to 15 percent may signal early development of PAD, while a difference of 50 percent signals moderate to severe PAD.
• Ultrasound: Sound waves are used to measure blood flow in the arteries and determine whether there is a blockage.
• Computed Tomography (CT) Angiography or Magnetic Resonance Angiography: Both tests produce images of arteries; the CT exam uses X-rays, while the MRA does not. For both exams, a patient will be injected with a dye or other contrast agent to make the arteries more visible.
  

Treatment

Treatment will depend on the severity of the PAD. Potential treatment options include:

Lifestyle changes: The doctor may recommend quitting smoking, beginning a supervised exercise program and eating a low-fat diet to reduce cholesterol.

Medication: The doctor may prescribe medication to reduce cholesterol and blood-pressure levels, as well as antiplatelet medicines to prevent blood clots from forming. A patient may also receive medicines to help in walking longer distances.

Medical procedures: For severe PAD cases, a procedure may be required to break up blockages caused by PAD or route blood flow around a blockage. Procedures offered at UVA include:

• Subintimal angioplasty: UVA is a regional pioneer in the use of this procedure, which inserts a wire into the wall of the affected artery. Once the wire passes the blockage, it is moved into the artery and a balloon is inflated to open the artery. Subintimal angioplasty is especially effective in treating longer blockages.
• Minimally invasive bypass grafts: Similar to heart-bypass procedures, veins are taken from elsewhere in the body and used to reroute blood flow around a blockage in the artery.
• Stents: Stents are inserted to open a blocked passageway to improve blood flow.
• Mechanical thrombectomy device: The device is used to break up blockages in the artery, improving blood flow.