Peripheral Arterial Disease
Understanding and Treating Peripheral Arterial Disease
Peripheral Arterial Disease is a form of peripheral vascular disease often affecting the arteries in the legs, leading to pain and other symptoms. Restricted blood flow to the legs due to plaque buildup in the arteries, Peripheral Arterial Disease (PAD) can cause pain and discomfort but is manageable with early diagnosis, lifestyle modification, medical management and possibly targeted intervention, allowing patients to restore circulation and improve mobility.
What is Peripheral Arterial Disease?
Peripheral Arterial Disease (PAD) is a condition in which the arteries supplying blood to the legs and lower extremities narrow or become blocked due to plaque buildup. The plaque buildup, known as atherosclerosis, is composed of cholesterol, fatty substances, and cellular waste, which restricts blood flow and limits oxygen delivery to the leg muscles.
PAD is a condition marked by reduced blood flow to the legs and lower extremities due to plaque buildup in the arteries. This buildup, called atherosclerosis, consists of cholesterol, fatty deposits, and cellular debris that gradually narrow or block the arteries. PAD most commonly affects the legs, leading to discomfort, pain and in advanced cases can lead to more severe complications. Untreated PAD can lead to critical limb ischemia, a serious condition that can result in non-healing wounds, tissue damage, or even limb loss.
Several risk factors contribute to the development of PAD, including:
- Smoking: Smoking nicotine, tobacco products and other substances.
- Diabetes: Diabetes type 1 and diabetes type 2
- Uncontrolled Hypertension
- Hypercholesterolemia
- Family History: Genetics play a significant role in blood vessel development and health. A family history of vascular diseases can indicate an increased risk of developing PAD or other vascular conditions that have similar symptoms.
- Other Health Conditions: Obesity and a sedentary lifestyle can also increase the likelihood of PAD.
Managing potential risk factors is essential to prevent the development and progression of PAD. Also, taking steps to combat potential vascular conditions is important for preventative care. If you are person with a family history of vascular conditions this further necessitates the need for a clean diet, regular exercise and avoidance of smoking and other activities that have adverse health effects. Early detection of PAD is crucial in improving the outcome of the treatment and the earlier the condition is detected the better the probability is that the condition can be treated with less invasive endovascular procedures that reduce the recovery times and stress on the body
Symptoms of Peripheral Arterial Disease
- Leg Pain or Claudication: The most common symptom of PAD is intermittent claudication, a cramping or aching pain in the calf, thigh, or hip muscles that occurs during walking or exercise. This pain typically eases with rest but returns with physical activity.
- Leg Numbness or Weakness: Reduced blood flow can lead to weakness, numbness, or heaviness in the affected leg, making it difficult to perform physical activities. Reduced blood flow deprives the leg muscles and nerves of oxygen and essential nutrients. Those muscles without adequate circulation, may feel weak, numb, or heavy.
- Coldness in the Lower Leg or Foot: The affected limb may feel colder to the touch compared to the other leg due to reduced blood circulation.
- Sores or Wounds that Heal Slowly: Reduced blood flow due to PAd can hinder wound healing, leading to non-healing sores or ulcers, particularly on the feet and lower legs.
- Discoloration and Hair Loss: Affected skin may become a pale bluish color, and the hair on your leg or foot may stop growing or start falling out.
- Weak Pulse in Leg or Foot: In severe cases, a healthcare provider may notice a weak or absent pulse in the affected leg or foot. The weak pulse in the affected limb is due to low blood pressure caused by the restriction of blood flow in the limb.
PAD Causes and Risk Factors
The primary cause of PAD is atherosclerosis, the buildup of fatty deposits along the arterial walls, which restricts blood flow. Several factors increase the risk of developing PAD:
- Smoking: Tobacco use is one of the highest risk factors for PAD. Smoking accelerates atherosclerosis and damages blood vessels which impairs circulation.
- Diabetes: Diabetes contributes to PAD by causing inflammation and damage to blood vessels, especially in the legs. The higher levels of inflammation and blood vessel damage make PAD worse by further restricting blood flow.
- High Blood Pressure and Cholesterol: High blood pressure and cholesterol contribute to plaque buildup, which further narrows the arteries. Avoiding high cholesterol intake is important for anyone with a history of vascular conditions in their family.
- Age: The risk of developing PAD increases with age, particularly in individuals over 50.
- Family History: A family history of cardiovascular disease or PAD increases one’s likelihood of developing the condition.
- Obesity and Sedentary Lifestyle: Lack of physical activity and excess body weight put additional strain on the circulatory system and contribute to the buildup of plaque.
Understanding these risk factors can help with early identification and lifestyle adjustments to prevent PAD or slow its progression. If you need help building a personal plan to address these causes or risk factors, contact us at Glendale Vascular to speak with our office to get a vascular health checkup.
Diagnosis of Peripheral Arterial Disease
At Glendale Vascular, we utilize several diagnostic methods to accurately assess PAD. Our board-certified surgeons in Los Angeles, carefully test and observe blood flow and identify arterial blockages using the following techniques:
Physical Examination
For the initial physical examination, a doctor will check for a reduced or absent pulse behind the knee, in the feet and in the groin. A stethoscope is used to listen for a pulse or a whooshing sound over the arteries in those locations. If the pulse is weak or absent it signals reduced blood pressure and is an important first step in identifying PAD and planning further tests.
Ankle-Brachial Index Test
The Ankle-Brachial Index (ABI) is a widely used, non-invasive test that compares blood pressure in the ankle with blood pressure in the arm. A doctor will check for discrepancies in blood flow between the limbs using a blood pressure cuff and an ultrasound machine. The ABI is a reliable blood flow comparison test for identifying differences in blood pressure that may be due to PAD.
Ultrasound
Ultrasound imaging is highly effective in evaluating the blood flow through the arteries in the legs. At Glendale Vascular we have a Vascular Ultrasound Lab that we use to identify and visualize blood flow blockages, obstructions and narrowing. Ultrasounds are non-invasive and accurate test methods for diagnosing PAD.
Angiogram
An angiogram is an imaging test that can be used to diagnose PAD by showing detailed images of blood flow and blockages in the arteries. To perform the test, a doctor will inject contrast dye into the blood vessels and take a series of x-ray images that will identify blood flow blockages or vessel narrowing.
CAT Scan and Magnetic Resonance Imaging
CAT scans and Magnetic Resonance Imaging (MRIs) are used to get detailed images of the affected arteries to help the doctor see where blood flow is blocked or narrowed. These tests are especially helpful when a closer look is needed to understand how severe the blockage is and to plan the best treatment for PAD.
Treatment for Peripheral Arterial Disease
- Quit Smoking: Smoking worsens PAD and quitting is crucial to improving vascular health.
- Blood Pressure and Cholesterol Control: Medications and diet adjustments to help keep blood pressure and cholesterol at healthy levels, slowing plaque buildup.
- Diabetes Management: Protect blood vessels and prevent worsening of PAD.
- Exercise Program: A supervised exercise program can improve circulation and the muscles that can help regulate blood pressure.
- Angioplasty: Angioplasty is an endovascular procedure where a catheter is inserted into the affected blood vessels to guide a small balloon to the site of the narrow vessels. Once in place, the balloon is inflated to widen the artery, improving blood flow. After the artery is expanded, the balloon is deflated and removed.
- Stent Placement: Often combined with angioplasty, a small wire mesh tube, called a stent, is guided into the artery with a catheter. Once the stent is in position a small balloon inside the stent is inflated, expanding both the stent and the artery. This process widens the artery to improve blood flow. After the artery is sufficiently dilated, the balloon is deflated and removed, leaving the stent in place to support the artery and prevent future narrowing.
- Atherectomy: Atherectomy is a minimally invasive procedure used to remove plaque buildup from an artery, improving blood flow and relieving symptoms of PAD. This procedure is performed with a catheter that has a specialized device, such as a blade or rotary tool, designed to physically cut or shave away the plaque from the arterial walls. The traditional atherectomy method is most suited for clearing calcified plaque in larger arteries and cutting through hard blockages in elastic and muscular arteries.
- Laser Atherectomy: In laser atherectomy, the catheter is equipped with a laser that emits pulses of light energy to vaporize plaque buildup. The precision of the laser makes it suitable for removing softer plaques and treating blockages in medium to large arteries, especially in areas where traditional atherectomy tools may not be effective. Laser atherectomy is valuable in treating PAD in larger arteries of the legs and can improve blood flow with minimal damage to surrounding tissues.
- Bypass Surgery: Bypass surgery creates an alternative route for blood flow around a blocked artery. Using a graft, either from a healthy vein in the patient’s leg or from a synthetic material, the surgeon redirects blood flow to an artery further down the leg. Bypass surgery is highly effective for restoring blood flow and is typically recommended for advanced PAD. The surgeons at Glendale Vascular have performed hundreds of bypass surgeries for PAD in the legs, also known as lower extremity bypass, this treatment is reserved for Peripheral Arterial Disease cases that can not be resolved with less invasive endovascular procedures.
- Types of Peripheral Bypass Grafts:
- Vein Grafts: Commonly taken from the patient’s own leg, vein grafts are effective for bypassing blocked arteries near or below the knee. The saphenous vein is often used, as it provides a durable and compatible option for restoring blood flow in the lower extremities.
- Synthetic Grafts: Made from materials compatible with the body, synthetic grafts are used primarily for arteries above the knee.
- In Situ Bypass: This method leaves the vein in place, connecting it to the artery above and below the blockage. A small camera (angioscope) may be used to assist with the procedure. This is an effective bypass method that does not rely on natural or synthetic grafts.
- Endarterectomy: Endarterectomy is a surgical procedure used to remove plaque buildup from the femoral artery in the leg. A small incision is made in the groin area, exposing the femoral artery to the surgeon. The femoral artery is then clamped above and below the blockage to temporary stop blood flow to the affected area. The artery is cut open and the surgeon removes the plaque buildup that was blocking the artery, once the plaque is removed the area is flushed with saline to remove small debris. Once the area is cleaned the artery is closed with sutures or a patch made from natural or synthetic material. The leg incision is then closed back up and the procedure is over. Endarterectomy is a relatively short and low-risk surgery and is the best treatment for severe blockages in the femoral artery.
Contact Glendale Vascular for Expert Diagnosis and Treatment of Peripheral Arterial Disease
If you’re experiencing symptoms of PAD or are concerned about your vascular health, the team at Glendale Vascular is here to provide expert care. Our specialists offer advanced diagnostic tools and personalized treatment plans to improve circulation, alleviate symptoms, and help you live an active, healthier life. Schedule a consultation with our board-certified vascular specialists today and take the first step toward better vascular health.