Peripheral Arterial Disease (PAD or PVD)

Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication).

PAD is relatively common, affecting more than 10 million people in the U.S. It is more common in people who are 65 or older, but can occur at nearly any age. Smoking; high blood pressure; high cholesterol or triglycerides; diabetes; kidney failure; and obesity increase your risk for PAD.

Diagnosis

SEE A VASCULAR SURGEON
You will be asked questions about symptoms and medical history, including questions about family members. The vascular surgeon will also perform a physical exam.

TESTS MAY BE RECOMMENDED
● Ankle-brachial index (ABI). This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm.

You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.

● Ultrasound. Special ultrasound imaging techniques, such as Doppler ultrasound, can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
● Angiography. Using a dye (contrast material) injected into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor is able to trace the flow of the contrast material using imaging techniques, such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA).

Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment. After finding the narrowed area of a blood vessel, your doctor can then widen it by inserting and expanding a tiny balloon or by administering medication that improves blood flow.

● Blood tests. A sample of your blood can be used to measure your cholesterol and triglycerides and to check for diabetes.

PAD is usually treated by aggressively managing the risk factors with lifestyle changes and medication. This includes :

● Cholesterol-lowering medications. You may take a cholesterol-lowering drug called a Statin to reduce your risk of heart attack and stroke.

• High blood pressure medications: If you have high blood pressure, your doctor may prescribe medications to lower it.

• Controlling your blood sugar (glucose) levels becomes even more important while suffering from diabetes.

● Medications to prevent blood clots. PAD is related to the reduced blood flow to your limbs, it’s important to improve that flow. Your doctor may prescribe daily aspirin therapy or another medication, such as Clopidogrel (Plavix).
● Symptom-relief medications: The drug Cilostazol increases blood flow to the limbs both by keeping the blood thin and by widening the blood vessels. It specifically helps treat symptoms of claudication, such as leg pain, for people who have peripheral artery disease. Common side effects of this medication include headache and diarrhea. Not all patients benefit from this medicine

Angioplasty and surgery

In some cases, angioplasty or surgery may be necessary to treat peripheral artery disease that’s causing claudication:
● Angioplasty. In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow.

Your doctor may also insert a mesh framework called a stent in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.

● Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic (man-made) fabric. This technique allows blood to flow around — or bypass — the blocked or narrowed artery.
● Thrombolytic therapy. If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.