Peripheral Arterial Disease

African Americans are at considerably higher risk than Caucasians of developing PAD.

At the mention of blocked blood vessels one usually thinks of the heart. But vascular blockage can also occur outside the heart, in arteries that carry blood to other areas of the body. This condition is called peripheral arterial disease (PAD). PAD most commonly affects the lower extremities, sometimes making simple activities like walking to the mailbox or taking an afternoon stroll painful or even impossible. The symptoms of PAD should be taken seriously because they could indicate the presence of heart disease. At Lewis-Gale Heart Center, we diagnose and treat all conditions of the cardiovascular.

What Is PAD?

Peripheral arterial disease, also called peripheral vascular disease, affects millions of people in the United States, most often men over age 50. Like coronary artery disease, it’s a form of arteriosclerosis (“hardening of the arteries”).

In a healthy individual the inner lining of arterial blood vessels is smooth, allowing oxygen-rich blood to flow easily. When PAD is present the lining becomes damaged with the buildup of plaque (fatty deposits such as cholesterol) and the artery becomes narrow, even progressing to total closure. Over time the insufficient supply of oxygen to muscles and other tissues can cause serious damage.

What Causes PAD?

Peripheral arterial disease results from the same risk factors that cause arterial blockage in the heart:

• family history of heart disease or stroke
• smoking
• diabetes
• obesity
• lack of physical activity
• high blood pressure
• high blood cholesterol

Of these, cigarette smoking is by far the most important risk factor, particularly for those who smoke more than 15 cigarettes a day. African Americans are also at increased risk, with a two- to three-fold chance of developing PAD.

What are the Symptoms of PAD?

Peripheral arterial disease impairs the vessel’s ability to permit increased blood flow to muscles when needed, such as during exercise. That’s why people with PAD may feel pain in the hips, buttocks or calves when they are walking or engaged in physical activity that subsides when they are at rest. Other symptoms of PAD affecting the lower extremities are:

• decreased hair growth
• shiny skin
• ulcers or sores
• tingling or numbness
• coolness in the affected leg or foot
• shrinking of the calf muscle
• thickened toenails.

How is PAD Diagnosed?

The standard screening test for PAD is an ankle-brachial index (ABI) that uses a special ultrasound stethoscope to compare blood pressure in the arm to blood pressure in the ankle. Lower blood pressure in the ankle implies a blockage between the heart and leg and could represent PAD.

If an ABI indicates peripheral arterial disease, an ultrasound test is then performed. This noninvasive study provides images of vessel anatomy and blood flow to verify diagnosis.

How is PAD Treated?

Changes in lifestyle can often slow the progression of PAD. Medication also plays a role in managing the disease. Of the 2.5 million diagnosed cases of PAD, 2.1 million are managed medically. In severe cases of PAD, however, interventional therapy is needed.

Before an artery can be opened the exact location of the blockage or narrowing must be determined. An arteriogram is performed in which a small needle and catheter are inserted into the artery. A safe dye is injected and images are recorded as the dye flows down each leg. This technique provides a roadmap of the normal and abnormal arteries and enables the physician to determine the appropriate therapy.

ANGIOPLASTY - Angioplasty is a procedure in which a small balloon is used to dilate a narrow segment of an artery. It is sometimes followed with stenting in which a tiny metal cylinder, or stent, is inserted into the vessel to support and hold it open.

SURGICAL BYPASS GRAFT - In a bypass graft, a vein grafted from another part of the body, or a graft made from an artificial material, is used to create a detour around a blocked artery. The best treatment for peripheral arterial disease depends on a number of factors including overall health, location of the affected artery, and the size and cause of the blockage or narrowing of the artery.

About Lewis-Gale Heart Center

Lewis-Gale Heart Center provides diagnosis and treatment of peripheral arterial disease. We offer low-cost ABI screenings to the community and to area workforces. Our non-invasive cardiovascular lab, cardiac catheterization suites, and surgical suites are equipped with the latest technology and skilled, experienced staffs. Our interventional radiologists and vascular surgeons are experts in their fields. And we provide follow-up education and care so patients get the most out of life.

For more information use the following links:

Diagnostic Cardiology

Imaging/Diagnostic & Vascular Services

Interventional Cardiology

Electrophysiology Procedures for Arrhythmias

Cardiovascular Surgery

Chest Pain Center

Patient Care Departments