peripheral artery disease

Peripheral Artery disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart.

In PAD, the arteries that carry oxygenated blood throughout the body become narrowed or even blocked, usually as a result of atherosclerosis, or plaque. Your doctor may recommend certain lifestyle changes to treat your condition. Bypass surgery or interventional procedures such as angioplasty, catheter-directed thrombolysis or atherectomy may be used to help improve blood flow.

People who smoke and/or have diabetes are at especially high risk. People older than 50 years of age with a history of diabetes mellitus or smoking should have an ankle blood pressure test. In addition, anyone older than 65 years of age should undergo an ankle blood pressure test to evaluate for PAD. 

Peripheral artery disease is often caused by atherosclerosis.

The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs.

PAD diagnosis begins with a physical examination. Your healthcare provider will check for weak pulses in the legs. Your physical examination may include the following:

  • Ankle-brachial index (ABI): a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes only a few minutes and can be performed by your healthcare professional as part of a routine exam. Normally, the ankle pressure is at least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent.
  • Doppler and Ultrasound (Duplex) imaging: a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage. 

  • Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.  
     
  • Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without using X-rays. 
     
  • Angiography: (generally reserved for use in conjunction with vascular treatment procedures) during an angiogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint any blockages that may be present. Learn more about peripheral angiogram.

You often can successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet. Other interventions may be needed to restore blood flow:

Angioplasty

In an angioplasty procedure, an interventional radiologist threads a catheter through a blood vessel to the affected artery and inflates a small balloon to reopen it. In some cases, the insertion of a stent is required to help keep the artery open. Stents are either balloon-expandable or self-expanding metallic scaffolds that remain permanently in the blood vessel after implantation.

Bypass surgery 

Surgeons perform bypass surgery by grafting a vessel from another part of your body or using a synthetic graft made of fabric, allowing blood to flow around, or bypass, the blocked or narrowed artery.

Catheter-directed Thrombolysis

 In this minimally invasive treatment, an interventional radiologist uses a catheter to reach the site of the blockage and injects a drug to dissolve the blood clot.

Atherectomy 

This minimally invasive procedure uses a catheter to reach the site of the blockage. There, a small blade or laser is deployed to remove the arterial plaque. The catheter captures the collected plaque in a chamber in the tip. The process can be repeated to treat additional plaque.