Ask the Expert: What Is Peripheral Artery Disease?

Peripheral artery disease (PAD) causes blockages in your blood vessels that reduce the flow of oxygen- and nutrient-rich blood from your heart to tissues in organs or limbs. Although PAD can affect both arms and legs, the most common form of PAD occurs in the lower extremities. 

“PAD occurs because of a buildup of plaque in the arteries, known as atherosclerosis,” said Dimitrios Virvilis, MD, Catholic Health Vascular Surgeon. “As plague builds, your blood vessels become increasingly narrower until completely blocked.”

PAD is treatable and preventable but often goes undiagnosed until symptoms appear. “Knowing PAD risk factors and symptoms can help with early diagnosis and treatment,” said Dr. Virvilis.

What are the risk factors for peripheral artery disease?

Risk factors for PAD include:

• High blood pressure
• High cholesterol
• Diabetes 
• History of blood clotting disorder
• Having kidney disease
• Smoking
• Sedentary lifestyle
• Family history of heart disease and PAD

What are the symptoms of peripheral artery disease?

“Pain and cramping when walking, especially in the legs, is the most common symptom of PAD,” said Dr. Virvilis. “The longer PAD goes undiagnosed, walking greater distances will become harder, and the pain and cramping will worsen.”

Other symptoms of PAD include:

• Coldness in a lower leg or foot
• Numbness or weakness in the leg
• Sores on toes, feet or legs that do not heal 
• Redness or color changes on the leg

How is peripheral artery disease diagnosed?

Your doctor will recommend one or more noninvasive tests to evaluate your blood vessels and blood flow, such as:

• Vascular ultrasound and other noninvasive vascular tests
• Computed tomography (CT) angiography
• Magnetic resonance (MR) angiography

 “Once you are diagnosed with PAD, you and your doctor will evaluate the best treatment measures based on the severity of the disease,” said Dr. Virvilis. 

How is peripheral artery disease treated?

Lifestyle habits

“Changing your lifestyle habits makes a significant difference in controlling PAD,” said Dr. Virvilis.

He noted that patients with PAD often can avoid invasive treatment like surgery when they make healthier life choices. That includes:

• Eating a well-balanced diet that limits fatty, high-cholesterol and high-sugar food
• Exercising regularly
• Maintaining a healthy weight
• Controlling blood pressure
• Not smoking
• Not drinking excessively 
• Managing stress 

“For some PAD patients, lifestyle modification is not enough, said Dr. Virvilis. “Your doctor will discuss options like medication, minimally invasive surgical treatment, and more complex procedures for advanced disease.”

Medication

Medications that treat high blood pressure, high cholesterol and diabetes can also treat risk factors for PAD and reduce the likelihood of a heart attack or stroke. Those medications include statin medications and antihypertensive medications.

Your doctor may also prescribe an antiplatelet medication like aspirin, Plavix (prevents blood clots) and Cilostazol (improves blood flow to reduce leg pain). 

“You and your doctor will review the best medication options for you,” said Dr. Virvilis. “Take your medications exactly as prescribed and follow up with your doctor if you are experiencing side effects.”

Minimally invasive procedures

Endovascular (minimally invasive vascular surgical procedures) to treat PAD include:

• Angioplasty. A vascular specialist guides a special small balloon through catheters to the blockage, where the balloon inflates to open up the blockage. Sometimes, special medicated balloons will deliver medication to the vessel wall to reduce plaque build-up.
• Stenting. A vascular specialist inserts an expandable stainless steel metal coil in a narrowed vessel to keep it open.

Advanced procedures

Advanced surgical procedures may be required for patients who have severe PAD and are at high risk for limb loss (critical limb ischemia). 

Those procedures include:

• Bypass graft. Blood flow is rerouted around a blocked artery segment with a graft using a healthy vein from your arm or leg or from synthetic material.
• Hybrid. Combines minimally invasive endovascular surgery and open surgery.

“Our goal with PAD patients is to make sure the disease does not become severe enough to increase their risk for limb loss, which has a tremendous impact on someone’s life,” said Dr. Virvilis. “It is essential to talk to your vascular specialist if you are concerned that you are at risk for or are showing symptoms of PAD.”

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