Peripheral Vascular Interventions

In the treatment of Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to you arms and legs.  It is also likely to be a sign of accumulation of fatty deposits in your arteries throughout the body including your heart and brain.  Often, you can successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet.

Common Symptoms:

  • Most common is (intermittent claudication) - painful cramping in your hips, thighs and or calf muscles after activity such as walking or climbing stairs.
  • Leg numbness or weakness.
  • Coldness in your lower leg or foot, especially when compared with the other leg or foot.
  • Sores on your toes, feet or legs that won't heal.
  • A change in the color of your legs.
  • Hair loss or slower hair growth on your feet and legs.
  • Slower growth of your toenails.
  • Shiny skin on your legs.
  • No pulse or a weak pulse in your legs or feet.
  • Erectile dysfunction in men.
  • Progression of the disease may even cause pain while at rest or lying down (ischemic rest pain).

Risk Factors:

  • Smoking
  • Diabetes
  • Obesity (Body Mass index over 30)
  • High Blood Pressure (140/90 or higher)
  • High Cholesterol
  • Under age 50 with 2 or more risk factors noted above
  • Over age 50 with a history of Diabetes or Smoking
  • Over age 70 even if no symptoms
  • Family history of PAD, heart disease or Stroke
  • High levels of homocysteine, a protein component that helps build and maintain tissue.

Tests and diagnosis:

  • Physical Exam by your physician who will look for signs of PAD such as weak or absent pulse.
  • Ankle Brachial Index (ABI) compares the blood pressure in your ankles with the blood pressure in your arm.
  • Arterial Duplex Ultrasound which uses sound waves to take images of the arteries and the blood flow helping to identify blockages or narrowed arteries.
  • Angiography which is done in the hospital in a cath lab.  The physician uses a dye (contrast) which is injected into the arteries to show the blood flow.  During this injection X-rays are taken which help to identify the blockages, location of the blockages and the narrowing of the arteries. Although this is invasive, it allows for simultaneous diagnosis and treatment (see below).

Medications and Treatments:

  • Cholesterol-lowering medications - Statins reduce your risk factor of heart attack and stroke.  The goal in patients who have PAD is to reduce the low-density-lipoprotein (LDL) "Bad" Cholesterol to less than 100mg/dL  The goal is even lower if you have additional major risk factors for heart attack and stroke, especially if you are diabetic or if you continue smoking.
  • High blood pressure medication - If you also have high blood pressure your doctor may prescribe medications to lower it. The goal of this is to reduce your systolic blood pressure (top number) to 140mmHg or lower and your diastolic blood pressure (bottom number) to 90mmHg or lower.  If you are diabetic your target should be 130/80mmHg or lower.
  • Medications to control blood sugar - If you also have diabetes, it becomes even more important to control your blood sugar (glucose) levels.  Talk with your doctor about what your blood sugar goals are and what you need to take to achieve those goals.
  • Medications to prevent blood clots - Since PAD is related to reduced blood flow to your limbs, it's important to reduce your risk of blood clots.  A blood clot can completely block an already narrowed blood vessel and cause tissue death.  Your doctor may prescribe oral antiplatelets such as Plavix, Brilinta or Effient  to help prevent blood clots.
  • Symptom-relief medications - The drug cilostazol (Pletal) or pentoxifylline (Trental) increases blood flow to the limbs both by preventing blood clots and by widening the blood vessels.  It specifically helps treat symptoms of claudication (leg pain).

 

  • Treatment with Peripheral Intervention (Angiography) - In this procedure a small hollow tube (catheter) is inserted 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 used to open heart arteries.

 

 Note:  People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow.