Peripheral Artery Disease

Peripheral artery disease (PAD) is a condition that impacts the blood vessels in the legs or lower extremities, causing them to become narrow or blocked. The blockage is caused by plaque buildup in the leg arteries.

The buildup of plaque is caused by several factors including a history of smoking, diabetes, high blood pressure, high cholesterol, and being over the age of 50.

In the United States, over eight million people are affected by PAD, which can impact mobility and cause pain. There are several options for improving the symptoms associated with PAD, including lifestyle changes and minimally invasive medical procedures.

Understanding Peripheral Artery Disease

Your arteries carry fresh, oxygenated blood from your heart, while your veins carry the blood back to your heart and lungs. But as you age, the artery can develop buildup of fat, cholesterol, or calcium. This is when PAD, which is also called peripheral arterial disease or peripheral vascular disease, develops.

When an individual develops PAD in the legs, they are not receiving enough blood to keep up with your body’s needs. It can cause pain or cramps, particularly with exercise. This type of pain is called claudication and can occur in the thigh, calf, or buttocks, making walking difficult. This pain caused by PAD may significantly limit your ability to engage in the physical activities you enjoy.

The rate at which PAD progresses varies with each individual and depends on many factors, including where in the body the plaque has formed and the person’s overall health. Risk factors for PAD include:

Smoking
High cholesterol
High blood pressure (hypertension)
Diabetes
Previous history of a heart attack or stroke
Age above 60
Obesity

Identifying Symptoms and Early Signs of PAD

If you are at risk of PAD, it is essential to understand the symptoms and early warning signs so you can take action before the disease begins to impact your movement. Only one in four people experience typical peripheral artery disease symptoms, such as pain, aching, or heaviness in the legs. Many people do not have any symptoms, particularly early on in the disease.

As the condition progresses, more significant signs that the condition is progressing may develop, including:

Absent pulses in the foot or leg
A pale color when the foot is elevated
Decreased hair or tissue fat
Toenails may stop growing

Symptoms can also include:

Pain or heaviness, especially with physical activity, called intermittent claudication
Weakness or numbness that makes it hard to walk

If you have any of these signs or symptoms of vascular disease in the legs or other extremities, you should seek the help of a vascular surgeon to help diagnose and treat your condition before it becomes severe.

Diagnosing Peripheral Artery Disease

If you are at increased risk or have developed symptoms of PAD, your doctor may WILL first start with a physical exam and ask you questions about your medical history. There are several simple, painless, and non-invasive tests for diagnosing PAD.

The simplest test is an ankle brachial index (ABI), which is an initial test followed by a lower extremity arterial ultrasound. This will help you and your surgeon determine the next steps.

Tests for diagnosing PAD should be performed in a vascular lab accredited by the Intersocietal Accreditation Commission (IAC), which we offer at Empire Vein and Vascular Specialists.

The IAC offers the highest standard of accreditation to only a handful of labs that meet the criteria of their rigorous review process. We are the only labs with this accreditation in the Inland Empire and Palm Springs areas. The accreditation indicates a highly trained staff, safe and quality procedures are established, and all testing procedures are vetted by the organization.

Exploring Treatment Options for PAD

There are several peripheral artery disease treatment options available, including outpatient options with a minimal recovery period that can be performed in our surgery center. But the first step for treating mild PAD is to control the risk factors that caused it in the first place. We also always recommend that patients start a walking program of 30 minutes a day to build collateral circulation.

If conservative management has failed, the first step in the treatment of PAD is a minimally invasive angiogram. This is an outpatient procedure performed in a surgery center. The procedure lasts approximately one hour with a few hours of recovery.

Under twilight anesthesia, a small puncture is made in the skin of the groin. The vascular surgeon can then use angioplasty (balloon inflating in the artery), place a stent, or perform an atherectomy, a procedure that utilizes a catheter and a small device we like to refer to as a “roto-rooter” that glides along the artery walls to capture and remove plaque from a blood vessel. The removed plaque is captured within the device, preventing it from traveling elsewhere in the body. The goal of treatment is to reduce the buildup of plaque in your arteries.

Recovery from this procedure is quick, and the patient is on their feet within just a few hours. Patients who undergo successful angiograms often notice that the discomfort in their legs is resolved after the procedure

Another treatment option for PAD is shockwave angioplasty, also called shockwave intravascular lithotripsy (IVL), which can be done during the angiogram. This procedure uses sonic pressure waves to break up calcium deposits, allowing blood flow to be restored.

Bypass surgery, also called lower extremity or leg bypass, is another treatment option for PAD that your doctor may explore if other types of therapies are not an option. This procedure is similar to a road detour, the surgeon uses a natural or synthetic graft to route blood flow around a blockage.

A surgical bypass requires general anesthesia. An incision is made at the crease of the groin and at the endpoint of the blockage. A graft is inserted via the incision and sown to both ends of the artery to “bypass” the blockage. The procedure takes between an hour and a half to six hours. Most patients need to stay in the hospital for two to five days for monitoring. Once you are discharged, it may take a few weeks for you to be able to completely resume normal activities.

Speak to your doctor about the best treatment options for you.

Preventing and Managing Peripheral Artery Disease

In addition to medical treatments for PAD, many lifestyle changes can help prevent complications and manage symptoms. These include living a healthy lifestyle by not smoking, eating a balanced diet low in saturated fat, maintaining a healthy weight, and exercising regularly. Managing other medical conditions that increase your risk, such as diabetes, high blood pressure, or cholesterol, can also help.

Our board-certified physicians at Empire Vein & Vascular Specialists are here to help you manage existing symptoms of PAD and reduce complications. To get started, call 1-800-VARICOSE today or book a screening online.

My legs hurt. Do I have Peripheral Arterial Disease (PAD)?

Not necessarily! While PAD can cause leg pain, cramps, coldness, and discoloration in the extremities, there are many other causes of leg pain. Other causes may include arthritis, muscle cramps, a pinched nerve, and others. Talk to your doctor about your symptoms, and they will take a detailed medical history to help identify the potential causes. Your doctor can also order noninvasive testing such as an ankle brachial index (ABI) or an ultrasound to determine if you have PAD.

I have been diagnosed with PAD. Is there anything I can do to make it better?

While no medication currently exists to eliminate PAD, there are many things a patient can do to slow down the progress of PAD and improve their symptoms. First and foremost is to control any risk factors that can make the condition worse, such as quitting smoking, eating a healthy diet, and exercising. Controlling high blood pressure and cholesterol with lifestyle changes, and if needed, medications can also help improve the symptoms of PAD.

I have been diagnosed with PAD and have pain in my legs when walking. Why is my doctor telling me to walk even more?

Pain in the legs during physical activity due to PAD is caused by lactic acid buildup in the muscles caused by poor blood flow. This can lead to discomfort in the legs when walking short distances.

Research shows that patients who start an exercise regimen of brisk walking for 30 minutes or more a day will begin to develop collateral or detour arteries in the legs, which will help improve the blood flow. Over time, this will increase the distance that a patient can walk before they notice the discomfort.

Is there a “Drano” type of medication that can dissolve the plaque in my arteries?

Unfortunately, not. At present, multiple medications can treat many of the risk factors that cause PAD to help slow its progress. Your physician may also prescribe a blood thinner medication to aid in the treatment of PAD.

I have tried the conservative options, and my legs still hurt. What type of doctor should I see?

A board-certified vascular surgeon is a specialist in disorders of the circulation in the legs. All of our physicians at Empire Vein and Vascular Specialists are board-certified vascular surgeons who specialize in helping people improve their vein health and have performed over 4,870 lower extremity angiograms (PAD) procedures. When you visit us, we can discuss a variety of treatment options to improve your symptoms.

Do I need ongoing follow-up?

Follow-up is very important after intervention for PAD. The vascular team will schedule follow-up ultrasound visits for surveillance to check for any plaque that may develop in the future. Patients are also encouraged to maintain strict control of their risk factors to decrease the likelihood of recurrence.

Why should I choose Empire Vein and Vascular Specialists for evaluation of my PAD?

Our practice has over 30 years of collective experience in treating PAD. Empire Vein and Vascular Specialists have a state-of-the-art surgery center offering the latest technology.

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