What is Peripheral Artery Disease (PAD)?

PAD is caused by atherosclerotic disease or plaque buildup inside the blood vessels carrying blood to your legs.

An estimated 8.5 million Americans and more than 200 million people worldwide have PAD. If you have PAD, you are at increased risk of heart attack and stroke. The 5-year death rate among patients diagnosed with PAD may be as high as 33 percent, with most deaths due to heart attack and stroke.

What is Critical Limb Ischemia (CLI)?

CLI is the most severe and deadly form of PAD. CLI is defined as ischemic rest pain, foot/toe ulcers, or gangrene. Approximately 2 million US citizens suffer from CLI. CLI is on the rise due to the rise of diabetes and kidney disease. Patients with CLI have a major amputation rate as high as 40 percent at 6 months and a mortality rate of 20 to 25 percent in the first year after diagnosis. At 5 years, the all-cause mortality rate of 70 percent exceeds that of colorectal cancer, breast cancer, stroke, and coronary artery disease. Oftentimes CLI patients undergo amputation without any type of vascular evaluation by a highly trained vascular interventional physician who has expertise in non surgical treatment techniques.

Risk Factors

• Smoking
• High Cholesterol
• High Blood Pressure
• Diabetes
• Renal Failure
• Obesity

Who is at risk for PAD?

• Patients under 50 years of age with diabetes mellitus and one or more additional risk factors for atherosclerosis/plaque buildup
• Patients 50 to 64 years of age with one of the risk factors above or family history of PAD
• Patients 65 years of age or older
• Patients with known atherosclerotic disease/plaque buildup in another part of the body including the heart, neck (carotid artery), arms (subclavian artery), abdomen (abdominal aortic aneurysm, renal artery narrowing, or narrowing in arteries of the bowel).

Signs/Symptoms

The most common symptom of PAD is leg pain and claudication, which is leg pain that occurs when walking or exercising and disappears at rest.

Other symptoms of PAD/CLI include discoloration, numbness, and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don't heal.

Diagnosis

• Your doctor will perform a complete history and physical exam and possibly order blood tests.
• Ankle-brachial index or ABI is calculated using blood pressures from the arms and feet at rest. An ABI that is less than 0.90 confirms the diagnosis of peripheral arterial disease.
• Other tests may include a combination of Duplex Ultrasound of the leg arteries, blood pressure measurements of the blood flow in the legs (PVR, Segmental Pressures).
• TcPO2/TCOM test which measures the oxygen level of the tissues below the skin using sensors on the foot is helpful in patients with ulcers/sores/wounds.
• CT Angiogram or MR Angiogram of the legs which are CT or MRI scans of the arteries in the legs using contrast injected into an arm vein.

Treatment

Depending on the location and severity of your PAD/CLI and your risk factors, your doctor may prescribe an exercise program, medications, help you stop smoking, or recommend treatment. Treatment can include outpatient procedures such as angioplasty or stent placement.

Vascular Interventional radiologists pioneered many of the outpatient non surgical vascular treatments including angioplasty and stenting, which was first performed to treat PAD. Using various cameras to see inside the body, vascular interventional doctors guide a small catheter which looks like IV tubing through the femoral artery in the groin to the blocked artery in the leg. Then he or she inflates a balloon (angioplasty) to open the narrowed or blocked blood vessel. In some cases, the narrowed or blocked artery may not stay open with angioplasty alone and a scaffold called a stent is needed to keep the artery open. These treatments are outpatient, minimally invasive, and performed through a tiny nick in the skin the size of a pencil tip using local anesthesia and light sedation medications.

Recovery is usually a few hours or possible one night hospital stay. Most patients have immediate improvement in their symptoms.

Follow up clinic visits are scheduled every few months to make sure symptoms are not recurring.

Why Choose UHealth?

Expert care from highly trained interventional radiologists. Our interventional radiologists and radiology specialists are experts in a variety of minimally invasive procedures — everything from treatments to clear blocked blood vessels to advanced cancer therapies like NanoKnife®.