Does leg pain make you stop when walking? Arterial disease may be the cause of your leg pain and in severe cases may even lead to an amputation. Peripheral artery disease (PAD) is a term used to describe disease of the arteries outside of the heart. These are the key facts about peripheral arterial disease (PAD) you need to know.
The most common cause of peripheral arterial disease (PAD) is atherosclerosis, which is a progressive buildup of plaque inside the arteries. As the disease progresses, the arteries start getting narrowed and can ultimately become blocked, leading to a decrease in oxygen and nutrients to the tissues.
There are many risk factors associated with PAD, some of which may be modified and some of which may not. The two most common risk factors are diabetes and tobacco use. Other important risk factors include age (especially after age of 50), high blood pressure, high cholesterol, coronary artery disease, male gender, physical inactivity and obesity.
At least 12 million Americans are affected by PAD and roughly 50% of these cases are asymptomatic. However, moderate to severe disease may lead to lifestyle limiting symptoms and even amputations. The most common symptom associated with PAD is known as intermittent claudication and consists of muscle cramping associated with activity (usually after walking a specific distance). Typically this pain is reproducible and relieved by rest. Intermittent claudication may occur in one or both legs and its severity varies depending on the degree of arterial narrowing or blockage. Although not specific to PAD, other signs and symptoms include decreased foot temperature, shiny brittle skin of the legs or feet, leg hair loss, thickened toenails, bluish discoloration of the legs or feet, and weak pulses.
Severe cases of PAD may lead to critical limb ischemia, which is characterized by chronic pain, non-healing leg or foot wounds/ulcers or gangrene. These are the patients with the highest risk for an amputation. Fortunately, if treated promptly by an interdisciplinary care team, such as the one in Wellington Regional Medical Center, up to 85% of amputations can be prevented!
Signs and symptoms of PAD may mimic other diseases. An adequate diagnosis is key and starts with a complete medical history and physical exam. This is followed with more advanced non-invasive diagnostic studies among which the most common are ankle-brachial index (compares blood pressure in the arm and leg). Pulse volume recordings and segmental pressures, Doppler ultrasound, and CT scan or MRI of the blood vessels (also known as CTA and MRA). An angiogram involves inserting a small catheter into the blood vessels under real-time x-ray and injecting dye. This study is minimally invasive and is usually reserved for those cases in which treatment will be performed simultaneously.
Identifying the disease early and knowing the treatment options lead to better outcomes! It is important to understand that most of the patients with peripheral arterial disease (PAD) will never progress into severe disease. In addition, being diagnosed with PAD does not mean you will require a vascular intervention. Treatment options are tailored to the degree of disease a patient has and how symptomatic the patient is. Making lifestyle changes including smoking cessation, keeping a healthy diet, and doing exercise are all key not only for PAD treatment but for the treatment of many other diseases.
Blood pressure, blood sugar and cholesterol control is very important and usually involves taking medication. This is why visiting your health care provider routinely is very important.
Vascular interventions are usually reserved for patients with moderate to severe PAD with lifestyle limiting symptoms (such as short distance claudication) and for those with critical limb ischemia (rest pain, non-healing ulcers, gangrene) who are at a very high risk for amputation. Vascular interventions include endovascular procedures as well as open surgery.
Endovascular procedures are minimally invasive, usually performed under mild to moderate sedation and patients go home the same day. These types of procedures are basically painless and involve placing a catheter inside the arteries of the legs. Through this catheter, different devices and techniques are used in order to fixed the arterial narrowing’s and unclogging them when necessarily.
At Wellington Regional Medical Center (WRMC), we have an interdisciplinary care team for PAD. This team of professionals is represented by different specialties to evaluate and manage patients with PAD. In cases of severe disease, such as critical limb ischemia, our goal is limb salvage with amputation prevention. WRMC has a group of professionals with a vast experience in advanced endovascular revascularization, foot surgery, surgical revascularization, wound heal therapies (including hyperbaric chamber treatment) and medical evaluation and care.
For more information or to schedule a complimentary screening visit, please call our outpatient scheduling service at (561) 877-3920.
Juan Gomez, MD
Director, Vascular and Interventional Radiology
Wellington Regional Medical Center
Diplomate, American Board of Radiology