PAD - Peripheral Arterial Disease

What is Peripheral Arterial Disease

You arteries deliver oxygen-rich blood from your heart to other parts of your body. Your peripheral arteries carry blood away from the heart to your arms and legs.

Healthy peripheral arteries are smooth and unobstructed, allowing blood to flow freely to the legs and provide oxygen, glucose, and other nutrients that your legs need. Typically with age, the peripheral arteries build up plaque, a sticky substance made up mostly of fat and cholesterol. Plaque narrows the passage way within the arteries and causes them to become stiff. Peripheral arterial disease results when arteries become too narrow or obstructed and limit the blood flow to the legs. If left untreated, peripheral disease can cause pain or aching in the legs, difficulty with walking, resting pain in the foot at night in bed, non-healing sores or infections in the toes or feet, and can lead to limb loss in its most severe form. PAD can be associated with other serious arterial conditions leading to heart attacks and stroke.

Causes and Risk Factors

  • Age
  • Gender - males are more prone to the condition than females
  • Hypertension (high blood pressure)
  • Diabetes
  • Smoking
  • High Cholesterol
  • Obesity
  • Lack of Exercise
  • Family History of Vascular Problems

Symptoms

There may be no symptoms in the early stages of peripheral arterial disease. Developing symptoms may include discomfort or pain in your legs when walking but no pain when you rest.

Diagnosis

The diagnosis of peripheral arterial disease can be established, and its severity confirmed, by a simple, noninvasive Doppler examination.

If you experience symptoms of peripheral arterial disease in your legs, see a vascular surgeon. They are the only physicians treating peripheral vascular disease today who can perform all the treatment options available, including medical management, minimally invasive endovascular angioplasty and stent procedures, and open bypass surgery.

Treatment for PAD

A number of options are available for treating PAD, including surgery and non-surgical treatments, such as angioplasty and vascular stent placement. The risks and benefits of these treatment options should be discussed with your physician.

Vascular Surgery

In the past, surgery was the only treatment available for PAD and, in some cases, surgery may still be needed. When surgery is required, the surgeon implants a new vessel (a natural or synthetic vascular graft) that allows blood to bypass the obstruction.

Angioplasty

In recent years, a minimally invasive procedure called Percutaneous Transluminal Angioplasty, PTA, has been developed. During angioplasty, a doctor inflates a tiny balloon inside the vessel, compressing the plaque against the vessel walls. The balloon then deflates and is withdrawn from the vessel. This procedure is performed entirely within the vessel through a small puncture in the skin. However, because angioplasty does not always restore blood flow effectively, the doctor may recommend placement of an intravascular stent in the vessel.

Intravascular Stent

An intravascular stent is a small tube that is introduced into a blocked artery. The stent is gently expanded to open the vessel, restore blood flow, and relieve symptoms. The stent remains in the vessel as a permanent implant.
Stent implantation is performed by interventional doctors who are specially trained to perform such interventions.
The entire procedure usually lasts between 45 minutes and an hour and a half.

During recovery, the patient must lie flat for several hours without moving the affected leg. Following a stent procedure, many patients can go home on the same day. In some cases, the doctor may ask the patient to remain in the hospital overnight.

The healthy lining of the vessel will slowly grow over the stent, permanently incorporating it into the vessel wall. The stent will not limit daily activities in any way, and stent patients can almost always return to their normal activities. Patients who have had vascular stent implants should tell this to any doctor who treats them in the future.

After treatment, the doctor usually recommends that patients with PAD adopt a program of controlled exercise combined with lifestyle changes, including cessation of smoking and, if cholesterol is high, a special diet. Since athersclerosis has been described as a "silent disease", patients diagnosed and treated for PAD should schedule periodic medical examinations and reduce their risk of further disease by making the healthy lifestyle choices recommended by their doctors. Patients receive medication after stenting to promote good function of the stent.

Conclusion

Stent implantation is an exciting option for patients with PAD and a major improvement in the way this disease is treated. It enables patients with PAD to get better without traditional surgery. With a stent, patients can get back on their feet right away - without leg pain - and return to a more active and independent life.

Glossary of Terms

Arteriogram: An x-ray of the arteries after a special dye has been injected into the body.
Atherosclerosis: A disease in which fatty substances, such as cholesterol, are deposited on the inner lining of blood vessels.
Balloon Catheter: A tube with a tiny balloon used to open an artery.
Catheter: A tube used for gaining access to one of the body's cavities. In angioplasty, a catheter provides access to the arteries.
Claudication: Pain in the leg that occurs with work or exercise, but may also occur when resting.
Lumen: The inside diameter if a vessel.
Percutaneous Trans-luminal Angioplasty: A balloon procedure to open an obstruction or narrowing of a blood vessel.
Vascular Graft: Implant of a new vessel in the vascular system.
Vascular System: The heart, blood, and network of blood vessels that lead to and from the heart.

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