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Peripheral Artery Disease/Critical Limb Ischemia

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.

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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 to open the blood vessel where it is narrowed or blocked (angioplasty). In some cases, the blocked artery may not stay open with angioplasty alone and a scaffold is needed called a stent. These treatments are outpatient, minimally invasive, performed with local anesthesia and light sedation medications, using 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.

Accepted Insurances

Note: Health plans that are currently contracted with UHealth are listed below. However, please check with your insurance provider to verify that UHealth is part of your provider network.

  • Aetna WC
  • Aetna Affiliates/Signature Adm (ASA)
  • Aetna Behavioral Health
  • Aetna Elect Choice (EPO)
  • Aetna Florida Healthy Kids
  • Aetna HMO
  • Aetna Medicaid HMO
  • Aetna Medicare HMO
  • Aetna Medicare PPO
  • Aetna POS
  • Aetna PPO
  • Aetna UM Employee HMO 1
  • Aetna UM Employee HMO 2
  • Aetna UM Employee POS HRA
  • Aetna/Coventry Institutes of Excellence (IOE)
  • Amerigroup Florida Healthy Kids
  • Amerigroup Medicaid HMO
  • Argus Vision
  • AvMed Choice
  • AvMed HMO/POS
  • AvMed MDC and JHS Groups
  • AvMed Medicare HMO
  • AXIS
  • BCBS Blue Options Network Blue PPO
  • BCBS BlueCare HealthOptions HMO
  • BCBS BlueChoice PPC/PPO
  • BCBS Miami Dade Blue PPO Limited Benefits Plan
  • BCBS of Florida (All products except "SELECT" Plans)
  • BCBS of Florida (Commercial plans exclude HIX Select)
  • BCBS Traditional PHS/PPO
  • Beacon Health (ValueOption)
  • Beech Street PPO
  • Broward Health Medical Center
  • CarePlus Medicare HMO
  • Catholic Hospice
  • CCP/CMS Title XIX (Medicaid Enrolled in South Florida)
  • CCP/CMS Title XXI (Non Medicaid Enrolled in South Florida)
  • CCP/MMA (Broward County residents)
  • Charlotte County Sheriffs Office PPO
  • Cigna Affiliates
  • Cigna Behavioral Health
  • Cigna Dental HMO/PPO
  • Cigna EPO
  • Cigna HMO
  • Cigna Life Source (Intracorp is part of Cigna Lifesource)
  • Cigna MDCPS Jackson Sr. High
  • Cigna POS
  • Cigna PPO
  • Cigna Shared Administration
  • Clear Health Alliance SNP Medicaid HMO
  • Concordia Behavioral Health
  • CorVel WC
  • Coventry First Health WC
  • Coventry Health Care of Florida (HIP) HMO/POS
  • Coventry Health Care of Florida (HIP) PPO
  • Coventry Health Plan of Florida (Foundation) HMO
  • Coventry Health Plan of Florida (Foundation) POS
  • Coventry National PPO
  • Coventry Summit Medicare HMO
  • Coventry Vista Medicare HMO
  • Coventry First Health PPO
  • Delta Dental PPO
  • DentaQuest (ADI)
  • DIKLA
  • Dimension WC
  • Dimension Plus PPO
  • Doctor's Healthcare Plan
  • EHN PPO
  • EQUIAN (Health Systems International)
  • Europe Assistance/Global Corporate Solutions (Care Management Network)
  • eyeQuest
  • FCCI WC
  • Florida Community Care (FCC)
  • Florida Healthcare Plan (Affiliate of BCBSFL)
  • Florida PACE (FPC)
  • Freedom Health Medicaid HMO
  • Freedom Health Medicare HMO
  • Gallagher Bassett WC (MDCPS & FCSRMC)
  • Global Excel Mgt PPO
  • Great West (Cigna) HMO/POS
  • Guardian Life PPO
  • HAA Preferred Partners
  • Health First Health HMO/POS
  • Health First Health Medicare HMO
  • Health First Health PPO
  • Health Net Veterans Choice HMO
  • Heritage Summit Healthcare WC
  • Humana Behavioral Health (LifeSynch)
  • Humana Dental/CompBenefits/OHS
  • Humana EPO
  • Humana HMO
  • Humana Medicaid HMO
  • Humana Medicare HMO
  • Humana National Transplant
  • Humana PPO
  • Humana Premier
  • iCare Health Solutions
  • Interlink Health Services
  • International Kids Fund (IKF)
  • League Medical Concepts Federal Inmates
  • Life Trac
  • Magellan Behavioral Health
  • Magellan Complete Care SNP Medicaid HMO
  • MDAbroad
  • Medica Medicare HMO
  • Medical Development In't (MDI)-Federal Inmates
  • Medicus
  • Metlife Dental PPO
  • MHNet Behavioral Network (MHNet)
  • Molina
  • Molina Market Place
  • Molina Medicaid HMO
  • Molina Medicare HMO
  • Morgan White International
  • MultiPlan PPO
  • Naphcare (Federal Prisoners)
  • National Healthcare Solutions Inc.
  • Neighborhood HealthPlan HMO/POS
  • Neighborhood HealthPlan PPO
  • North Broward Hospital District PPO
  • Olympus Managed Healthcare
  • Optum
  • Positive Healthcare SNP Medicaid HMO
  • Positive Healthcare SNP Medicare HMO
  • Prestige Health Choice Medicaid HMO
  • Prime Health Services WC
  • Quality Health Management
  • Religious Order of Jehovah's Witnesses PPO
  • Rockport Healthcare Group WC
  • Royal Caribbean Cruises PPO
  • Sanus Health Corporation
  • Seasons Hospice
  • Simply Healthcare Medicaid HMO
  • Solstice Dental HMO/PPO
  • Start Healthcare Network
  • Sunshine
  • Sunshine AMBETTER
  • Sunshine Healthy Kids HMO
  • Sunshine Medicaid HMO
  • Sunshine Medicare HMO
  • Tricare South Prime HMO
  • Tricare South Standard PPO
  • United Behavioral Health (UBH)
  • UnitedHealthcare Affiliates
  • UnitedHealthcare Healthy Kids HMO
  • UnitedHealthcare HMO/POS
  • UnitedHealthcare Medicaid HMO
  • UnitedHealthcare Medicare Nursing Home Plan
  • UnitedHealthcare PPO
  • University of Miami Athletic Dept PPO
  • VUMI
  • Wellcare/Staywell Healthy Kids HMO
  • Wellcare/Staywell Medicaid HMO
  • Wexford Health State Inmates
  • Worldwide Managed Care