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Peripheral Artery Disease

Peripheral arterial disease describes disorders of the circulatory system (including the arteries and veins) outside of the brain and heart. One of these conditions is known as peripheral arterial disease (PAD) which is a narrowing of the arteries in the legs or arms.

Causes of Peripheral Artery Disease

The most common cause of PAD is atherosclerosis, or buildup of plaque in the arterial walls. Plaque -- composed of cholesterol-rich fatty deposits, collagen and other proteins, as well as excess smooth muscle cells -- gradually accumulates causing the thickening of the arterial walls. This thickening narrows the vascular channels and impedes blood flow.

Age, smoking and diabetes are the most important risk factors for developing PAD. Obesity, a sedentary lifestyle, high cholesterol levels and high blood pressure also contribute to atherosclerosis.


Risks of PAD

PAD typically occurs after the age of 50, although it can affect some smokers as early as age 20. Diabetes and smoking greatly increase the risk of PAD.  PAD shares the same risk factors as coronary artery disease, and these conditions often occur together. The disease may worsen if left untreated, in some cases even leading to tissue death (gangrene).

Symptoms

Fewer than half of people with PAD experience symptoms. Most frequently, those symptoms include:

  • Muscle pain in the calves or thighs of one or both legs that occurs when walking, especially fast or uphill. Pain subsides with rest. It may also occur in the fingers, arms, buttocks, lower back, or the arch of the foot.
  • Impotence (erectile dysfunction).
  • When the disease is severe, pain occurs while the person is at rest which is called critical limb ischemia. Symptoms may include:
    • leg or foot pain at rest that worsens at night
    • discolored or blue toes
    • cold or numb feet
    • sores on the feet or legs that do not heal

These symptoms may be due to aortoiliac disease (pelvic vessels) or femoral popliteal disease (thighs and leg vessels). The vascular surgeons at FMH are experienced in diagnosing and treating these regions of vascular disease with both catheter-based and open surgical bypasses. Catheter-based treatment options may include angioplasty and stenting.

When to Call Your Doctor

Make an appointment with your doctor if you repeatedly develop muscle pain or discomfort in the legs while walking. Your doctor may order a simple test known as the ankle-brachial Index (ABI) - a comparative study of blood pressure in the arms and legs -to determine whether or not you have PAD.

Prevention

Some risk factors, such as age and family history, cannot be altered. But there are factors you can control to reduce your risk of developing PAD:

  • Don’t smoke.
  • Exercise regularly.
  • Eat a diet low in saturated fat, cholesterol and salt.
  • Have your cholesterol, blood sugar and blood pressure checked.
  • Lose weight if you are overweight


Diagnosis

Frederick Memorial Hospital has earned a reputation for excellence in patient care in the area of vascular disease. We specialize in the diagnosis and management of carotid artery disease, aortic aneurysms and poor circulation to the brain, kidneys and legs. We provide comprehensive services for all types of vascular conditions, from the less invasive technology of catheter-based intervention to traditional surgery.

Treatment

FMH physicians see patients with all disease processes affecting the circulatory system (arteries, veins and lymphatics). They are experts in the areas of endovascular therapy, vascular surgery, DVT treatment, wound care, and exercise rehabilitation

Your treatment plan that may include the following options:

  • Exercise is an effective treatment for PAD.   Each day, take a walk and continue walking until leg pain develops. Rest for a short time to let the pain subside, then continue walking. Gradually, the distance that can be traveled comfortably may increase. A supervised exercise program is ideal, such as that offered by our Medical Fitness Program.
  • Practice good foot care and check your feet every day. Poor circulation due to PAD slows the healing of sores. Spotting problems early may help to prevent minor foot problems from becoming major infections.
  • Medication is critical to reduce cardiovascular risk. Your physician will discuss options available to treat your PAD.
  • Angioplasty may be performed if the blood vessels are clogged with plaque. Using local anesthesia, the doctor will insert a catheter - a long, narrow tube - with a deflated balloon at its tip into the narrowed part of the artery. The balloon is inflated, compressing the plaque and enlarging the inner diameter of the blood vessel so blood can flow more easily.
  • Bypass surgery to re-route blood flow may be necessary in severe cases if angioplasty is unsuccessful. A vascular surgeon will use one of your veins or an artificial vein to bypass the blockage and thus provide a blood supply to the lower leg again.
 

                   

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