Peripheral Arterial Disease
What is Peripheral Arterial Disease?
Peripheral arterial disease (PAD) or peripheral vascular disease (PVD) occurs when the hardening of the arteries (atherosclerosis) causes a buildup of plaque in the blood vessels that carry oxygen and nutrients. As atherosclerosis worsens, it reduces essential blood flow to the limbs and can cause complete blockage of the arteries.
PAD commonly occurs in the legs, but can affect any blood vessel in the body. In its early stages, PAD may cause difficulty walking. In its most severe forms, however, it can cause painful foot ulcers, infections, and even gangrene.
People with PAD also are more likely to suffer heart attacks or strokes than those without the disease. Family history, smoking, and diabetes are all risk factors for developing PAD. A combination of these risk factors makes the disease very likely and usually more severe.
PAD Symptoms
- claudication or pain in the muscles of the legs during walking or other exercise
- pain in the ball of the foot or toes
- nighttime foot pains that improve when hanging one’s foot over the bed
- ulcers or sores on the foot, ankle, or toes that will not heal
- blue or black discoloration of the toes
Diagnosing PAD
In most cases, your doctor can diagnose PAD through a physical exam but cannot always measure its severity, especially if you have another condition such as diabetes. To measure the severity of PAD, your doctor will order a noninvasive test using a Doppler or ultrasound scan. In some cases, your vascular surgeon may decide to obtain more invasive testing with a CT scan, MRI, or angiogram.
An ankle-brachial index or ABI is a standard measure used by physicians to gauge the severity of PAD.
Treating PAD
Positive lifestyle changes and staying healthy are essential for PAD treatment. Certain medications may provide some benefit as does regular exercise and walking. In more severe cases of leg peripheral disease, lifestyle changes and medication may not be enough to improve your symptoms. The choice of the treatment depends upon the pattern and extent of the blockages, as well as other factors such as your overall health and the presence of other medical conditions.
Certified by the Board of Vascular Surgery, UPMC vascular surgeons have pioneered the surgical treatment and minimally invasive therapies for PAD and will help you determine which treatment option is right for you.
Minimally invasive therapy
Minimally invasive therapies include the use of balloon angioplasty and stenting, as well as other devices such as lasers and athertectomy (“rotorouter”) catheters. UPMC’s vascular surgeons have been involved with several large studies of stenting and the development of new balloons and devices for the treatment of PAD.
Bypass surgery
Bypass surgery creates a detour around a leg artery that has been narrowed or blocked. To create this bypass, your vascular surgeon uses a vein from another part of your body or a tube made from artificial materials. Surgery is sometimes the best option for certain patients. UPMC’s vascular surgeons are experts in minimally invasive and surgical treatment of PAD, and perform hundreds of these procedures every year. UPMC also is a major referral center for patients with complicated conditions or who need additional operations.
Amputation
In extreme cases, especially if your leg has gangrene and is not salvageable, your surgeon may recommend an amputation, but only as a treatment of last resort. Amputation is performed when the circulation in your leg is severely reduced and cannot be improved by other methods, or if the tissue is severely destructed and cannot be healed even if blood flow could be restored. The majority of patients with gangrene who are seen by a board certified vascular surgeon can avoid amputation or have it limited to a small portion of the foot or toes.
For more information on PAD, its symptoms and treatments, visit the Society for Vascular Surgery Website at www.vascularweb.org.