Peripheral Arterial Disease (PAD)
Peripheral Arterial Disease (PAD) also known as Peripheral Vascular Disease (PVD) is a condition where clogged or narrowed arteries limit blood flow to your head, organs and limbs. Atherosclerosis, one cause of PAD, is a process where cholesterol and scar tissue build up to clog blood vessels. This is sometimes referred to as “hardening of the arteries.” Blood clots are another cause of PAD.
Symptoms of PAD
The most common symptom is pain or cramping in the leg or hip, especially during walking or exercise. Other symptoms may include numbness, tingling, weakness or hair loss in the legs; coolness, burning or skin-color changes in the feet or toes; or sores that do not heal.
However, it is important to note that the majority of patients with PAD never experience any symptoms. Therefore, people with one or more of these risk factors should be screened periodically for PAD:
Risk Factors for PAD
• Over age 50
• Not exercising
• High blood pressure or cholesterol
• Family history of heart or vascular disease
The first step in diagnosing PAD is often an ankle-brachial index (ABI). This measures the ratio between the blood pressure at your ankle and the blood pressure in your arms. An ABI of less than 1.0 is typically considered abnormal, and your doctor may want to follow up with additional tests or treatment.
Some examples of additional tests may include:
- Segmental Pressure Examination – Blood pressure cuffs are placed at several points along the leg to determine the location of a clot.
- Toe Brachial Index – Similar to ABI, but blood pressure is measured at the toe instead of the ankle. Patients with diabetes often have calcified arteries that cause ABI readings to be artificially high. A toe brachial index may be more helpful as an initial screening tool for these patients.
- Exercise ABI – The ABI is measured after the patient walks on a treadmill. This may be compared to the resting ABI to determine whether there is a drop in blood flow with exercise.
- Pulse Volume Recording – This test uses blood pressure cuffs and ultrasound to study blood flow.
- Doppler Ultrasound – Sound waves measure blood flow in the vessels.
- Angiography – Detailed images of the blood vessels are produced using X-ray, magnetic resonance imaging (MRI) or computed tomography (CT) scanning. These images enable physicians to analyze blood flow and inpoint a blockage.
Most of these tests are not invasive, although some types of angiography require injecting a dye or inserting a catheter into your veins. Your doctor can provide a more detailed explanation of any follow-up tests that are recommended for you.
Often lifestyle changes or medications are all that’s needed.
Lifestyle changes may include:
- Low-fat diet
- Quitting smoking
- A foot-care program to prevent infection
Medications may be prescribed to:
- Lower cholesterol
- Control high blood pressure
- Prevent plaque build-up and blood clots
- Increase total walking distance and comfort
If lifestyle changes and medications are not enough, physicians may be able to open blocked blood vessels by inserting a tiny wire called a catheter into the vessel and using it to deliver one of these therapies:
- Angioplasty – A small balloon is inflated inside the vessel to open it up and restore blood flow.
- Thrombolytics – Drugs break up the blockage to clear the blood clots.
- Stents – A metal cylinder holds the blood vessel open to restore blood flow.
- Stent-grafts – A stent covered in synthetic fabric is used to strengthen the blood vessel wall.
In cases where a longer section of vessel is blocked, doctors may perform surgery to bypass the clogged vessel with a healthy vessel from another part of the body.
Contact your physician for an evaluation or, for referral to a physician with expertise in treating peripheral arterial disease, call MidMichigan Health Line at (989) 837-9090 or toll-free at (800) 999-3199.