Peripheral Arterial Disease
Hardening of the arteries is a red flag for vascular disease including heart attack and stroke. Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a very common condition affecting 12-20 percent of Americans age 65 and older.
PAD develops most commonly as a result of atherosclerosis, or "hardening of the arteries," which occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries that narrows and clogs the arteries. This is a very serious condition. The clogged arteries cause decreased blood flow to the legs, which can result in pain when walking, and eventually gangrene and amputation.
Peripheral Arterial Disease Facts
Because atherosclerosis is a systemic disease, people with PAD are likely to have blocked arteries in other areas of the body. Thus, people with PAD are at increased risk for heart disease, aortic aneurysms and stroke.
PAD is also a marker for diabetes, hypertension and other conditions. This is a major public health issue and the Society of Interventional Radiology recommends greater screening efforts through the use of the ankle brachial index (ABI) test.
This simple, painless test compares the blood pressure in the legs to the blood pressure in the arms to determine how well the blood is flowing and if further tests are needed. Each September, during Peripheral Vascular Disease Month, interventional radiologists participate in Legs For Life, a nationwide screening program sponsored by the Society of Interventional Radiology.
Symptoms of PAD Include Intermittent Leg Pain, Numbness and Tingling
The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.
Other symptoms of PAD include:
- Numbness and tingling in the lower legs and feet
- Cold lower legs and feet
- Ulcers or sores on the legs or feet that don't heal
Leg Pain: Don't Assume It's Just Old Age
Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.
- Peripheral Arterial Disease (PAD) is a disease of the arteries that affects 10 million Americans.
- PAD can happen to anyone, regardless of age, but it is most common in men and women over age 50.
- PAD affects 12-20 percent of Americans age 65 and older.
Women & Vascular Disease
Heart disease is the #1 killer of women in the United States. Like heart disease, peripheral arterial disease is under-recognized in women. Through early detection, the progression of vascular disease can be halted, saving women from future stroke, heart attack, and early death if PAD is detected early. For more information, visit the Women and Vascular Disease section of the Web site.
Get tested if you:
- Are over age 50
- Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
- Have high cholesterol or high lipid blood test
- Have diabetes
- Have ever smoked or smoke now
- Are overweight
- Have an inactive lifestyle
- Have a personal history of high blood pressure, heart disease, or other vascular disease
- Have trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is believed by resting
- Have pain in the legs or feet that awakens you at night
Peripheral Arterial Disease - Diagnosis
The most common test for PAD is the ankle-brachial index (ABI), a painless exam in which a special stethoscope is used to compare the blood pressure in your feet and arms. Based on the results of your ABI, as well as your symptoms and risk factors for PAD, the physician can decide if further tests are needed.
When the ABI indicates that an individual may have PAD, other imaging techniques may be used to confirm the diagnosis, including duplex ultrasound, magnetic resonance angiography (MRA) and computed tomography (CT) angiography.
The ABI Test for PAD
The ABI is a simple, painless test to help your physician determine if you have PAD. The blood pressure in your arms and ankles is checked using a regular blood pressure cuff and a special ultrasound stethoscope called a Doppler. The pressure in your ankle is compared to the pressure in your arm to determine how well your blood is flowing and whether further tests are needed.
Each September, during Peripheral Arterial Disease Awareness Month, interventional radiologists participate in Legs For Life, www.LegsForLife.org a nationwide screening program sponsored by the Society of Interventional Radiology Foundation. Some interventional radiologists offer screening year-round by appointment.
Peripheral Arterial Disease – Treatments
The best treatment for PAD depends on a number of factors, including your overall health and the seriousness of the disease. In some cases, lifestyle changes are enough to halt the progress of PAD and manage the disease. Sometimes, medications or procedures that open up clogged blood vessels are prescribed to treat PAD.
If decreased blood flow to the legs is causing injury to the feet and toes, a foot care program to prevent sores or infection may be prescribed. This may include referral to a podiatrist.
Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.
Like many patients with coronary artery disease caused by atherosclerosis, PAD patients frequently have elevated cholesterol levels that contribute to the disease. A low fat diet and other cholesterol-lowering strategies are often part of a treatment plan.
For many patients, lifestyle changes combined with medication can control the symptoms of PAD. Drugs that lower cholesterol or control high blood pressure may be prescribed. New medications that help prevent blood clots or the build up of plaque in the arteries, or that reduce the pain of PAD, also are appropriate for some patients.
Angioplasty and Stenting
Interventional radiologists are vascular specialists who pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin, to the blocked artery in the legs.
Then the interventional radiologist inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.
Balloon angioplasty and stenting has generally replaced invasive surgery as the first- line treatment for PAD. Early randomized trials have shown interventional therapy to be as effective as surgery for many arterial occlusions, and in the past 5 to 7 years, a very large clinical experience in centers throughout the world has shown that stenting and angioplasty are preferred as a first-line treatment for more and more processes throughout the body.
The long-term clinical results of stent placement to treat PAD are comparable to those of aortofemoral artery bypass surgery, with a much lower risk of associated morbidity and mortality. Surgery should be reserved for the rare patient in whom stenting can't be done or fails.
Interventional Radiologists Have the Most Extensive Training in the Least Invasive Treatment Options
Of all the modern medical advancements pioneered by interventional radiologists, perhaps the most significant has been peripheral angioplasty and stenting. Interventional treatments preserve future treatment options. This unique specialty offers multimodality state-of-the-art imaging and diagnostic expertise, coupled with an unparalleled clinical experience across specialties, and in-depth knowledge of the least invasive treatments.
Interventional radiologists are specialists in minimally invasive treatments, have a unique breadth of training and provide consults to every type of specialist. These specialists have an in-depth foundation in diagnostic radiology with specialized training in procedures performed using imaging to guide them. When it comes to best practices for safely performing minimally invasive medicine, interventional radiologists pioneered the standards for safety and quality.
Second Opinion – Interventional Radiologists Treat the Most Difficult Cases
Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. You can ask for a referral from your doctor, call the radiology department of any hospital and ask for interventional radiology or visit the doctor finder link at the top of this page to locate a doctor near you.
As minimally invasive experts, interventional radiologists are often able to treat very difficult cases that another vascular specialist might think requires surgery. Interventional radiology treatment is the standard for PAD, even in cases of severe critical limb ischemia and gangrene (tissue loss), because it preserves future treatment options. Surgical by-pass compromises the arteries and if it fails, angioplasty is no longer an option and patients go on to amputation.
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Reprinted with permission of the Society of Interventional Radiology © 2004, www.SIRweb.org. All rights reserved.