Peripheral Arterial Disease: Staying a Step Ahead
Peripheral Arterial Disease (PAD) is a condition that affects the circulatory system – the arteries, in particular – which are responsible for carrying oxygen and nutrients to your tissues. The condition is caused by buildup of plaque in the walls of the arteries, a process termed “atherosclerosis”, which also is the underlying cause of most heart attacks and strokes. Atherosclerosis plaques build up in the arteries over a person’s lifetime, and smoking, diabetes, high blood pressure, bad cholesterol, and family history are major contributing factors that accelerate this process. When the plaques grow large enough to cause blockages in the arteries of the legs, the blood flow to the tissues is compromised. This causes the muscles to become tired more easily and walking even short distances can cause aching, cramping and soreness. As the blockages become more severe, these symptoms are experienced even at rest. Some patients at this stage will dangle their leg off the side of their bed to make the pain go away, and this is because gravity is helping the blood trickle through the blockages when the leg is upright. At even more severe stages, the poor blood flow can cause the tissues to die, resulting in ulcers that won’t heal, gangrene and infections that lead to amputations.
- Age 50+ years
- High blood pressure and/or high cholesterol
- Smoking or tobacco use
- Heart disease
- Kidney disease
- Painful muscle cramps in hips, thighs, or calves when exercising, walking, or climbing stairs
- Coldness in legs and feet
- Color changes in legs or feet
- Shiny skin, loss of hair, thickening of the toenails
- Leg pain that worsens when lying flat and improves with standing or dangling the leg
- Foot or toe wounds that won’t heal or heal slowly
- Dark skin or “gangrene”
If you experience any of the above symptoms, it is crucial that you consult with your doctor. Many people dismiss the above symptoms as a normal part of aging, but they can lead to serious problems if ignored. People who are over the age of 50 who have diabetes, chronic kidney disease, history of heart disease or stroke should undergo a screening exam for PAD, even if they are unsure whether they have symptoms.
We use several painless non-invasive methods to screen for and diagnose PAD. One of the simplest tests is called an Ankle-Brachial Index (ABI). This test is performed simply by inflating blood pressure cuffs on the arms and legs and doing a calculation, comparing the ratio of blood pressures in the arms to the pressures in the legs. It takes about 20 minutes and results are available immediately. For patients with a high suspicion of PAD or positive findings on the ABI test, we will perform a Doppler Ultrasound of the arteries to identify the exact locations of the blockages and plan for treatment. This exam takes approximately 45-60 minutes to complete, and one of our vascular physicians will review the results with you immediately and put together a plan.
Treatment of PAD patients focuses on 3 major factors: Reducing leg symptoms, preventing progression of the disease, and reducing the risks of heart attack and stroke. Changes in lifestyle such as diet and exercise, stopping smoking, controlling blood sugar and blood pressure, and lowering bad cholesterol are the most affective ways to prevent PAD progression and reduce the risks of heart attack and stroke.
Patients with PAD symptoms that interfere with their daily activities will sometimes find relief through supervised exercising programs and medications to improve their blood flow. However, many will require a minimally invasive procedure called an “Angiogram” to restore flow through the clogged arteries. This procedure is also indicated as a first line treatment for patients with pain symptoms at rest, nonhealing wounds or gangrene. It involves mapping the arteries and blockages with x-ray dye, crossing the blockages with small wires, removing plaque with an “Atherectomy” device, and using balloons and sometimes stents to restore the arteries to their normal diameter. Angiograms are performed safely in our outpatient labs, and patients are able to go home within a couple of hours and resume their usual activities.
The Vascular Institute of Virginia has locations in Woodbridge, VA and Fredericksburg, VA for the treatment of Peripheral Arterial Disease (PAD). We offer minimally-invasive treatments for PAD in our outpatient medical facilities. Our Vascular & Interventional experts provide comprehensive treatment plans for patients who suffer from PAD. Call 703-763-5224 or email firstname.lastname@example.org to request a consult and screening for PAD.