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Peripheral Artery Disease (PAD)

Baylor Scott & White Heart and Vascular Hospital – Dallas

What is peripheral artery disease?

Early diagnosis and treatment is critically important to prevent severe damage

Many people associate vascular disease with the heart and brain, and the danger of having blocked arteries near those vital organs. But the most common circulatory problems are farther away—in the hands, arms, legs and feet. This condition is called Peripheral Artery Disease (or PAD), and the threat of PAD is compounded by the fact many people are unaware they're at risk for it.

"PAD is caused by atherosclerosis, or fatty deposit build-ups in the arteries that narrow or block blood flow to the extremities," said John F. Eidt, MD, RVT, RPVI, FACS, vascular surgeon on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas, and Vice Chair of Vascular Surgery. "The reduced blood flow can cause permanent damage that kills tissue or encourages infection that leads to the loss of limbs."

Two surgeons perform an operation in the OR

More than 8 million Americans have PAD

The American Heart Association estimates more than 8 million Americans have PAD, with the incidence growing as people age. As is the case for many health problems, smoking is the leading risk factor, but diabetes, high blood pressure, obesity and high cholesterol also contribute to peripheral artery disease.

How do I know if I have PAD?

Many PAD diagnostic techniques are painless

"Many patients with PAD in their lower extremities experience painful muscle cramping in their hips, thighs or calves when walking, climbing stairs or exercising," said Dr. Eidt. "In severe cases, leg pain may persist even after finishing exercise. Other signs are wounds on the feet or toes that heal slowly or not at all, gangrene or a significant difference in the temperature of one lower leg or foot when compared to the other."

For people experiencing peripheral artery disease symptoms or with a family history of vascular disease, Baylor Scott & White Heart and Vascular Hospital – Dallas PAD specialists have various diagnostic techniques, most of them non-invasive and painless. The most common is the Ankle-Brachial Index (ABI), which compares blood pressure in the feet with blood pressure in the arm to evaluate blood flow through the body. Other methods involve sophisticated imaging procedures.

A woman sits waiting to talk to the doctor

Non-invasive peripheral artery disease treatment options

Two doctors in full scrubs perform an operation in the operating room.

Individuals are eligible to receive supervised exercise therapy (SET) if diagnosed with PAD caused by arterial insufficiency, and if classic intermittent claudication (IC) is present. Exercise training helps slow the decline in the ability to function and move through daily activities.

"The best treatment frequently involves a combination of lifestyle changes and medications, rather than invasive procedures or surgery," said Dr. Eidt."Stopping smoking, getting blood pressure under control, exercising, eating a diet low in saturated and trans fats, and effectively managing diabetes are the most common treatments. Supervised exercise therapy is helpful and many insurance plans, including Medicare, often cover it. We may also prescribe medicine to lower blood pressure and cholesterol, and blood thinners to help prevent the formation of blood clots."

When these approaches are not enough, Baylor Scott & White Heart and Vascular Hospital – Dallas and Baylor University Medical Center, part of Baylor Scott & White Health can treat PAD with the same expertise and technology they draw on to battle heart disease, including angioplasty, which uses a tiny, balloon-tipped catheter inserted into the blocked artery to open it up by expanding the balloon. A wire-mesh tube, called a stent, is often placed in the newly opened artery through the catheter to maintain normal blood flow.

"In many, if not most cases, we can slow PAD's progression—or even reverse it—without surgical measures," Dr. Eidt said. "The key is to be aware of the dangers, maintain a heart-healthy lifestyle and come see us if you think you have a problem."

Peripheral artery disease (PAD) procedures
Lower Extremity Stenting
To treat patients with leg pain caused by an artery blockage in the leg, a type of peripheral artery disease, vascular surgeons on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas perform a surgical procedure called lower extremity stenting. In this procedure, the physician places a small metal tube (called a stent) into the artery to keep it open, rerouting the blood supply around the occluded artery.
Lower Extremity Bypass Surgery
An additional treatment option for artery blockage in the leg is lower extremity bypass surgery. Surgeons graft a vein from a different part of the body and attach it to the blocked artery, above and below the obstruction. This transplantation creates a new path for blood to flow around the blockage.
Upper Extremity Stenting
When artery blockage affects the blood supply to the arms and hands, a surgical procedure known as upper extremity stenting may be an option. Vascular surgeons on the medical staff at Baylor Scott & White Heart and Vascular Hospital – Dallas insert a stent (a small metal tube) into the blocked artery to facilitate blood flow and redirect the blood supply around the obstructed artery.
Upper Extremity Bypass Surgery
Another treatment for arm artery disease is upper extremity bypass surgery. In this vascular procedure, surgeons transplant a vein from another part of the patient's body and attach it to the clogged artery, above and below the obstruction. This process creates a new route for blood to move around the obstruction.

Frequently asked questions

 

Peripheral Arterial Disease, or PAD as it is often shortened, occurs when the arteries in the legs become narrowed or clogged with fatty deposits, otherwise known as plaque. The build-up of plaque causes the arteries to harden and narrow, a process called atherosclerosis. Atherosclerosis in the leg arteries reduces blood flow to the legs and feet, resulting in poor circulation.

PAD occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

Like other diseases related to the heart, PAD can be improved with lifestyle changes, medications, or, if needed, endovascular or surgical procedures.

Lower-extremity PAD affects about 8 million Americans. The presence of hardened arteries in the legs makes it more likely these people will have hardened and narrowed arteries leading to the heart and brain. People with PAD are at high risk of having a heart attack or a stroke.

When blood flow to the legs is severely reduced, people with PAD may experience pain when walking. PAD also can cause other complications that can lead to amputation.

Walking can greatly improve the quality of life for people with PAD. Research shows that a formal walking program can effectively reduce leg pain or cramps (claudication). Over time, walking may be a more effective treatment than medication or surgery for reducing leg pain.

For people with PAD, a regular walking program will:

  • Help you stay active
  • Help control blood glucose, blood pressure, cholesterol and body weight
  • Lower your chances of having a heart attack or stroke

People with diabetes are at higher risk for PAD. It is estimated that one out of three people with diabetes over age 50 has PAD. African Americans and Hispanics who have diabetes are at even higher risk for PAD.

People with both diseases are much more likely to have a heart attack or stroke than those who just have PAD, and they are more likely to die at a younger age.

Because diabetes can decrease feeling or sensation in the feet or legs, many people also may have PAD but not know it or it goes undiagnosed. In addition, when blood flow to your feet and legs is narrowed or blocked due to PAD, cuts or wounds are more difficult to heal, increasing the potential risk for amputation.

Warning signs of PAD:

  • Fatigue, tiredness or pain in the legs, thighs or buttocks that always happens with walking but goes away with rest
  • Foot or toe pain at rest that often disturbs your sleep
  • Skin sores or wounds on your feet or toes that are slow to heal

In addition to being a major cause of heart disease, cancer and lung disease, smoking also is the #1 cause of PAD. Smoking even half a pack of cigarettes per day may increase the risk of PAD by 30 to 50%.

Smoking speeds the build-up of plaque in the artery walls and increases the formation of leg artery blockages. Smoking constricts blood vessels and causes the blood to clot.

As a result, smoking causes PAD to get worse faster. PAD increases the chance of having leg pain or cramping even while at rest, losing a foot or a leg due to amputation, or having a heart attack or stroke. As many as one out of two people with PAD who continue to smoke will have a heart attack or stroke or die within five years.

Reasons to Quit Smoking

If you have PAD, quitting smoking may save your life and lower the risk of heart attack, stroke or death. In addition:

  • Your blood pressure will be lower in just a few days
  • If you have diabetes, the risk of foot ulcers, eye problems, nerve damage and kidney disease will be reduced
  • You will lower your risk of cancer of the mouth, throat, lungs and bladder
  • Within one year of quitting, your blood flow and breathing improve and your coughing and shortness of breath will reduce

High blood pressure not only increases the risk of heart attack, stroke, eye problems and kidney disease, but also the risk of PAD Over time, high blood pressure makes blood vessel walls rougher and thicker. There also is a greater build-up of plaque, which causes arteries to harden and narrow, which in turn makes it harder for blood to flow through the vessels.

Controlling your blood pressure is an important part of controlling or preventing PAD. Have your blood pressure checked at least two to four times a year and take action to keep your blood pressure in control.

Too much cholesterol in your blood causes the walls of blood vessels to become narrowed or clogged with fatty deposits called plaque. Plaque builds up and causes hardening and narrowing of the arteries (atherosclerosis), which slows or blocks blood flow.

PAD occurs when the arteries in the legs are hardened and clogged. When arteries harden in one part of the body, it is likely they have hardened in other parts, such as the heart and brain. Therefore people with PAD are at much higher risk for a heart attack or stroke. Studies show that controlling cholesterol levels can help people with PAD lower their chances of a heart attack or stroke.

People with PAD are at high risk for a heart attack or stroke because of the build-up of plaque in their blood vessels. If a piece of plaque breaks off, red blood cells (platelets) clump together inside the blood vessel to form a clot on top of the plaque. This clot can limit or even block the flow of blood to your heart or brain, causing chest pain, a heart attack or stroke. Medications are available that can help prevent blood clots from forming, reducing the risk of heart attack or stroke.

Most people with PAD do not have any symptoms. People with diabetes over the age of 50 should be tested for PAD. Testing is also recommended for people with diabetes under the age of 50 who have other risk factors, such as smoking, high blood pressure or cholesterol problems.

Like other cardiovascular diseases, PAD can be treated by lifestyle changes and medications that lower the risk heart attack or stroke.

These lifestyle changes include:

  • Quitting smoking
  • Taking medications to control blood pressure, cholesterol and blood glucose (if you have diabetes)
  • Taking anti-platelet medications such as aspirin
  • Getting regular physical activity such as walking for 30 minutes at least three or four times per week
  • Following a heart-healthy diet that includes lots of fruits, vegetables and low-fat dairy products moderate in total fat and low in saturated fat and cholesterol
  • Seeking a special PAD exercise program if you have pain or cramps in your legs

For most people with PAD, these tips may be enough to control the disease and even improve symptoms. When leg arteries are severely clogged or narrowed, endovascular procedures or bypass surgery may be needed to improve blood flow to the legs and feet.

Because of reduced blood flow, people with PAD are more likely to have foot problems. Minor problems such as cuts, sores or blisters may not heal quickly or heal at all.

Diabetes further increases the risk of people with PAD for foot problems. In addition to poor circulation to their feet and legs, they also may have nerve damage from high blood glucose levels. This nerve damage (or diabetic neuropathy) can cause loss of sensation in the feet. A person may not feel a small rock inside his or her sock that is causing a sore or a blister caused by poorly fitting shoes.

For people with PAD and diabetes, minor foot injuries can turn into serious infections. If these sores are not treated right away, they may lead to amputation of a toe, foot or leg. With PAD, you can prevent serious foot problems by taking care of your feet every day.

 

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