Peripheral artery disease (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. 

Acute Limb Ischemia

Acute limb ischemia is a severe form of PAD. It occurs when blood flow to a limb, often the legs or feet, is suddenly blocked, often by a blood clot. It can put the health of your limb at risk and requires emergency treatment to save the limb.

Critical Limb Ischemia

Critical limb ischemia (CLI) is the most severe and deadly form of PAD. CLI is defined as pain while resting, foot/toe ulcers or gangrene caused by narrowed or blocked arteries. 

Approximately 2 million US citizens suffer from CLI. CLI is on the rise due to the increase in the number of people with 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 surgeon or interventional physician who have expertise in surgical and nonsurgical treatment techniques and limb salvage. Seeing an expert could help save the limb from amputation and improve quality of life.

Risk Factors

You may be at risk for both PAD and acute limb ischemia if you have one or more of the following risk factors:

• Abdominal aortic aneurysm
• Age over 65
• Diabetes
• Family history of PAD
• Heart disease
• High blood pressure
• High cholesterol
• Kidney failure
• Obesity
• Smoking

If you have PAD, you are at increased risk of heart attack and stroke. The 5-year mortality rate among patients diagnosed with PAD may be as high as 33%, with most deaths due to heart attack and stroke.

Symptoms

You may have PAD if you experience symptoms such as:

• Cold sensation in the legs and feet
• Leg pain when walking or exercising
• Numbness or tingling in the lower legs and feet
• Skin discoloration in the leg
• Sores or ulcers on the legs and feet that don’t heal

You may be experiencing acute limb ischemia if your limb is:

• Pale looking
• Paralyzed
• Suddenly painful
• Very cold

At the University of Miami Health System, our experts provide minimally invasive treatment to improve blood flow and treat both PAD and acute limb ischemia. They have performed more than 1500 complex limb salvage procedures since 2011, helping hundreds of patients avoid amputation.

Tests

History and Physical Exam
Your doctor will perform a complete history and physical exam and possibly order blood tests.

Duplex Ultrasound
A duplex ultrasound of the leg arteries uses sound waves to study blood flow. This test is combined with taking blood pressure measurements of the blood flow in the legs, called segmental pressures.

Angiogram
A computed tomography (CT) angiogram or magnetic resonance imaging (MRI) angiogram of the legs are scans of the arteries in the legs using contrast injected into an arm vein. They show how and where your blood flows.

Ankle Brachial Index
Ankle brachial index or ABI will be obtained which is calculated using blood pressures from the arms and feet at rest. An ABI < 0.90 confirms the diagnosis of peripheral arterial disease.

TcPO2/TCOM Test
A TcPO2/TCOM test measures the oxygen level of the tissues below the skin using sensors on the foot. This test is helpful in patients with ulcers, sores, or wounds.

Treatments

Smoking Cessation
Your doctor may prescribe a smoking cessation program to help you quit smoking and improve the health of your blood vessels.

Medications
Some medications, such as statins or beta blockers, can help lower your cholesterol and blood pressure, reducing your risk for PAD.

Stent Placement
In some cases, the blocked artery may not stay open with angioplasty alone and a scaffold, called a stent, is needed. These minimally invasive treatments are outpatient, performed with local anesthesia and light sedation medications, and use only a tiny nick in the skin the size of a pencil tip. 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.

Exercise
Exercise can help improve blood pressure and blood flow throughout your body.

Angioplasty
Using various cameras to see inside the body, your doctor will 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 to open the blood vessel where it is narrowed or blocked.

Limb Salvage
Limb salvage procedures are carefully planned to restore blood flow to your limb and reduce your risk for amputation. A limb salvage procedure may involve multiple techniques, such as stenting, angioplasty or bypass, to ensure your limb receives enough blood to remain healthy. During a bypass, your doctor will take part of a healthy vein from elsewhere in your body and attach (graft) it above and below the clogged part of the vein. This grafted vein will help blood flow around the clot and restore blood flow to your limb.

Why Choose UHealth?

Leading-edge imaging care in South Florida. Our doctors are also researchers discovering new ways to improve diagnosis and treatment. That means you can get some of today’s most promising advancements through clinical trials. You benefit from the latest developments that are fast-tracked from the lab to the bedside.

Advanced, hard-to-find procedures. Our doctors are committed to caring for every patient. That’s why they offer the latest treatments, including limb salvage, endovascular grafting and thoracic outlet decompression, to improve your blood flow. 

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®.

All the care you need, from one physician. Our vascular surgeons perform a wide range of procedures so you can have the same physician for any vascular care you need as your condition changes. Whether you need a stent replaced or a vein grafted, you can always turn to the doctor you trust.

Experienced doctors, reliable results. UHealth vascular surgeons perform hundreds of stent placements, angiograms and more every year. You can rely on their experience to help you avoid complications and have a positive outcome.