Peripheral Artery Disease (PAD)

The tip of the atherosclerotic iceberg

Peripheral arterial disease (PAD) is a term that is used to describe vascular disease affecting the arterial blood vessels of the lower extremities. It is a chronic inflammatory condition in the walls of arteries, in large part due to deposits of lipoproteins (plasma proteins that carry cholesterol and triglycerides). It is also referred to as a "hardening" of the arteries or atherosclerosis and is heralded by ischemic symptoms caused by a narrowing or blockage in the arteries.

Mention blocked arteries and most people think of the heart. However, these blockages can affect other areas of your body, especially blood vessels in the abdomen, kidneys, legs, neck, and brain. Atherosclerosis can lead to a range of serious health problems, including high blood pressure, crippling leg pain, heart attack, stroke, aneurysms and even kidney failure. Millions of Americans over the age of 50 have PAD and the prevalence of this condition increases as people age.

Risk Factors

The following risk factors are associated with PAD:

  • Age 50 years or older
  • Diabetes
  • Smoking
  • High cholesterol
  • High blood pressure
  • Obesity
  • Physical Inactivity
  • A family history of heart disease or PAD

Symptoms

When a blood vessel is clogged, smaller blood vessels try to compensate by rerouting blood around the clog. This will eventually fail, however, because these "detours" simply cannot carry as much blood as the larger blood vessel. Starved of oxygen-rich blood, the muscles almost literally cry out in pain. Symptoms of PAD include:

  • Calf pain (i.e. Claudication) - usually starts after a period of walking and is relieved by a short period of rest
  • Thigh or Buttock pain – occurs when the arterial blockages are present above the groin level in addition to the mid-thigh level, which is typically associated with calf pain as described above
  • Impotence
  • Feet that are cold to the touch, with toes that may appear discolored or bluish when dangling
  • Weak or absent pulse in the lower extremities

Limb-Threatening Ischemia

If the arterial narrowings or blockages increase in number and severity then the following can occur: rest pain (pain in the forefoot at nite that wakes one up from sleep), non-healing ulcers or gangrene, usually at the foot level. Although not as common as claudication, severe complications can result when the lower extremities are continuously starved of oxygen-rich blood. If left untreated, limb-threatening ischemia can lead to the amputation of the toes or feet. Screening is therefore important to identify patients with PAD. before the occurrence of more serious complications.

Screening and Diagnosis

Diagnosis is made by taking a thorough medical history and performing diagnostic tests to determine how well blood flows through your vessels. Screening for PAD can be completed in our ICAVL accredited non-invasive vascular laboratory.

Who Should Consider Screening?

If you answer yes to any of the following questions, you may benefit from peripheral vascular screening:

  • Do you currently smoke or have a significant smoking history?
  • Do you have high blood pressure, high cholesterol, or diabetes?
  • Have you been diagnosed with heart disease or have a family history of heart disease?
  • Do you have a family history of aortic aneurysm or stroke?
  • Are you over age 55?

Types of PAD Screenings

Carotid Artery Ultrasound
To detect plaque and/or arterial narrowing that may increase the risk for stroke
Abdominal Aortic Ultrasound
To determine the size of the abdominal aorta
Ankle-Brachial Index (ABI)
To compare the blood pressure at the ankle with that in your arm to determine if there is significant lower extremity arterial narrowing or blockage

Please call 714-560-4450 to schedule a PAD screening appointment.

Treatment

Depending on your overall health and the extent of PAD, the specialists within VISOC may recommend a variety of conservative treatment options, including smoking cessation, control of high blood pressure or cholesterol, taking good care of your feet and following a daily walking program. If the arterial blockages increase in number or severity this may result in disabling claudication (calf pain) symptoms or limb-threatening ischemia more aggressive treatment options may be recommended. These options may range from less invasive techniques such as balloon angioplasty, stent placement or atherectomy (removing plaque using a small catheter) to surgical bypass that essentially re-routes blood around the affected area. We offer the latest in minimally invasive and open surgical techniques to treat the following conditions related to PAD:

  • Upper extremity atherosclerosis
    • Activity-induced arm pain or chronic fatigue
    • Non-healing finger ulcers
    • Subclavian Steal Syndrome
  • Lower extremity issues
    • Leg pain with walking (Claudication)
    • Foot pain at rest
    • Non-healing foot ulcers
    • Gangrene
  • Vasculitis
    • Non-healing, painful finger ulcers
  • Takayasu's arteritis (a.k.a. pulseless disease)
  • Arterial embolism and thrombosis
  • Blue-toe syndrome