Peripheral Artery Disease
Peripheral artery disease (PAD), also known as peripheral vascular disease, refers to a partial or complete blockage of the arteries that supply blood to other important areas of the body: the legs, kidneys or arms. It is caused by atherosclerosis — plaque that builds up and causes a narrowing or blockage in blood vessels.
If left untreated, severe blockages of the leg arteries can lead to gangrene, which can result in the need to amputate a leg, foot or toes.
Risk factors for PAD include high cholesterol, high blood pressure, smoking, diabetes or a family history of PAD. People over 50 are also at higher risk.
Symptoms of PAD include numbness, cramps or pain involving the buttocks, thighs and hamstrings or the calves and feet. Symptoms typically occur or worsen with exertion. Unfortunately, many people attribute these symptoms to the normal process of aging and about 75 percent of them don't seek medical help.
Your doctor may find a weak pulse in the arteries in your arms and legs, which may indicate the presence of PAD. Various tests are available to confirm a diagnosis, including:
- Ankle/brachial index — uses a hand-held ultrasound device to compare the ratio of blood pressure in the arms and legs.
- Doppler ultrasound — uses sound waves to produce images of blood flowing through arteries and estimates the degree of blockage.
- CT angiography — uses a CT scanner to take a series of images that are reconstructed on a computer and provide detailed pictures of the arteries.
- MRA (Magnetic Resonance Angiography): is a type of MRI that utilizes magnetic and radiofrequency waves to produce pictures of the arteries in the body, instead of traditional radiation. Gadolinium, a type of contrast material, is given via an IV.
- Arteriography — a procedure that uses contrast dye injected into a blood vessel, which allows physicians to directly visualize the areas of blockage on a monitor.
If a blockage is not severe, you may be able to control it by making changes to your lifestyle habits, including:
- Eating a healthy diet, such as a plant-based, Mediterranean diet
- Quitting smoking (Smoking, in fact, is one of the leading causes of PAD)
If you have other vascular risk factors, such as hypertension, diabetes and hypercholesterolemia, it is very important to have these issues addressed, as well.
Aspirin or Clopidogrel (Plavix) may reduce the risk of blood clots forming in the arteries – including blood clots in heart arteries which would lead to heart attacks.
Multiple studies have shown that the medication Cilostazol (pletal) may help patients with PAD to walk farther. While it’s not entirely known why how this medication helps with PAD, it does have anti-inflammatory properties and also appears to partially open blood vessels.
Talk to your cardiologist about the risk and benefits of these options.
Virginia Mason's team of interventional radiologists, vascular surgeons and interventional cardiologists work together to treat patients with PAD. Treatment will depend on your symptoms and the severity of your disease, as well as your overall general health.
If initial, conservative efforts are insufficient, various procedures may be considered including:
- Balloon Angioplasty — uses a tiny balloon inflated in the blocked area within the artery to restore blood flow. A stent (a small wire mesh coil) may also be deployed within the artery. In special circumstances, drug-coated stents or drug-coated balloons may be placed in the artery to help keep it open.
- Peripheral vascular bypass — involves taking a vein from another part of your body to create a detour around the blocked blood vessel. The graft is sewn above and below the blockage, allowing blood to bypass the obstruction.
- Atherectomy — allows partial removal of plaque within the arteries, either as a stand-alone therapy, or in addition to further angioplasty or stenting.
A thoughtful, integrated approach to vascular disease is essential for making sure patients have the best possible outcomes. The Vascular Center at Virginia Mason is a collaborative effort of interventional radiologists, vascular surgeons and interventional cardiologists.
Together we follow evidence-based guidelines to provide seamless integration of care and resources. Our mission is to help patients achieve their goals and live longer, more productive lives.
For more information on the Vascular Center, call (206) 223-6950.