Peripheral Artery Disease (PAD) Treatment

Peripheral Artery Disease

Peripheral Artery Disease is one of the most under-diagnosed conditions In the US.  Nearly 16 million people are effected.  Peripheral Artery Disease is the build up of blockage or plaque in the arteries of the legs.  PAD is a progressive disease that takes years to progress and is seen most in the over 50 community.

Symptoms

Symptoms of PAD include leg pain and cramping when walking, leg numbness and tingling. Color changes in the legs.  As PAD progresses the development of non-healing wounds is likely.  This is due to insufficient blood flow to the feet and calves from plaque build up in the arteries.  If left untreated this can develop into Gangrene and will likely lead to amputation.

Detection.  There are several diagnostic tools available to diagnose PAD.

Ankle Brachial Index (ABI)  an ABI is a simple measurement of blood flow in the arms and legs and comparing the two.  At CLA our test takes two minutes and can tell if there is a reduction in blood flow to the feet.

Ultrasound–  After a positive ABI an ultrasound will be done to determine location and severity of Blockage.  An ultrasounds looks at the inside of the vessels and allows us to determine a plan of care without having to perform a more invasive test.

Treatment Options

Medication

The first step in treating mild disease with limited symptoms is managing medications to prevent disease progression and reduce symptoms,  this may involve a walking program to stimulate blood flow.

Endovascular Treatment

There are several methods to opening the blockages inside the arteries.  The simplest is by using a balloon and stent along with a technique call atherectomy.

Atherectomy is the removal of plaque from inside the arteries to allow for more blood flow.  This is done prior to balloon and stenting.  CLA uses laser and rotational atherectomy,  we make the decision on which to used based on the makeup of your blockage.  Once we have removed as much blockage as possible we inflate a balloon inside the artery, known as Angioplasty.  We will leave the balloon inflated for several minutes to allow for the best possible outcome.  It is normal to feel mild discomfort during this portion of the treatment.  After the Angioplasty, we may choose to place a stent.  This all depends on the result of the balloon inflation.  If the result from the balloon was sub par then we will place the stent in the same area to better hold the artery open.  All of these can be performed at our office under mild sedation, typically in under an hour.    You will leave our facility typically within two hours and will have light limitation at home for the next 2 days.  This is a low-risk procedure with minimal complication risk,  the largest being the care of the access site at the groin.

Bypass –  Bypass surgery is typically our last option.  If stents and balloons have been unsuccessful then we will perform a bypass at the hospital.  This requires us to make a small incision and use your existing vein or a graft if your vein isn’t available or isn’t suitable for bypass.  The Dr. will attach the graft above and below the blockage restoring flow to the leg.  The recovery is typically a few days in the hospital and several weeks at home.

Risk Factors

Who is at Risk?

Peripheral Artery Disease is most prevalent in people over 50 with a history of:

  • Smoking
  • Claudication
  • Diabetes
  • Non-healing wounds
  • Gangrene
  • Hypertension
  • High Cholesterol
  • History of Heart Disease
  • History of Stroke
  • Discoloration of limbs