PAD is a very common condition affecting up to 20% of Americans age 65 years and older. It occurs due to atherosclerosis, or hardening of the arteries, within the arteries of the pelvis and legs. Atherosclerosis occurs when plaque, which is made of fat and cholesterol, builds up within the wall of the artery. This reduces the amount of blood that can flow through the arteries.
There are several risk factors for PAD, including hypertension, high cholesterol, smoking, obesity, diabetes, inactivity, and a personal or family history of heart disease. It is always important for these conditions to be addressed with your primary care physician to reduce your risk of PAD.
Many patients with PAD have no symptoms. Others experience leg pain, numbness, tingling, and coldness in the legs and feet. The pain, which is known as intermittent claudication, is muscle pain that typically occurs when walking and is relieved with rest. When the blockages become very severe, the symptoms can include pain at rest and gangrene, which can possibly lead to loss of the affected limb.
Diagnostic Tests for Peripheral Arterial Disease
Ankle-Brachial Index (ABI): This test compares the blood pressure in the arms to the blood pressure in the feet. In general, the two measurements should be similar. When the blood pressure in the arms is significantly higher than the blood pressure in the feet, it may mean that PAD is present.
Pulse-Volume Recording (PVR): This test evaluates the blood flow in the arteries of the legs. By wrapping blood pressure cuffs around the legs, it is possible to characterize blood flow in the legs with each beat of the heart. This is another way to determine if the flow of blood within the legs is normal or abnormal
Magnetic Resonance Angiography (MRA): This test uses an MRI scanner to obtain pictures of the arteries within the abdomen, pelvis, and lower extremities. By directly visualizing the arteries, it is possible to determine how extensive and how severe the disease is, both of which will play a role in deciding which treatment option is best for an individual patient. In order to visualize the arteries, contrast material or dye containing gadolinium is used. It is important to tell us if you have any history of kidney disease since gadolinium may not be safe to use.
Computed Tomography Angiography (CTA): This test is similar to an MRA but uses a CAT scan machine to obtain the pictures of the arteries within the abdomen, pelvis, and lower extremities. Contrast material or dye containing iodine is used to visualize the arteries. It is important to tell us at the time of this test if you have any history of kidney disease. This test may be preferable to an MRA in patients with stents or a pacemaker.
Catheter Angiography: This is an invasive test used to obtain definitive pictures of the arteries within the abdomen, pelvis, and lower extremities. This test is not typically performed until one or more of the non-invasive studies above have demonstrated the presence of PAD. This test is performed by placing a catheter, which is a very thin tube, directly into the arteries of legs. Once the catheter is in place, an iodine-based dye is injected into the arteries and images are obtained. These images help show the severity and extent of the blockages within the legs and help determine the most appropriate treatment option. Treatments such as angioplasty and stent placement can often be performed at the same time as the angiogram. When patients undergo these procedures, they do receive sedation through an IV.
Interventional Treatments for PAD
Angioplasty: In this procedure, a catheter is placed directly inside the artery that contains a blockage. The catheter used is a special catheter that has a balloon built into it. When the catheter is positioned within the blockage, the balloon is inflated, which disrupts the plaque that has caused the blockage and creates more room in the artery for blood to flow.
: In this procedure, a catheter is placed directly into the artery that contains a blockage. The catheter used in this procedure contains a stent, which is a tube made of wires. Once the catheter is positioned across the blockage within the artery, the stent is released inside the artery. The stent opens up space within the blocked artery which allows more blood to flow through that artery.