H. CHARLES-HARRIS, MD & ASSOCIATES

BREAST, GENERAL, VASCULAR, ENDOVASCULAR & ROBOTIC SURGERY

WHAT IS PAD?

“What is PAD?” (Peripheral Arterial Disease)

Peripheral Artery Disease is a condition of the blood vessels that leads to narrowing and stiffening of the blood vessels that supply the organs in to body. This includes the legs, brain and kidneys but also can affect the intestines and other structures such as the arms. This narrowing leads to decreased blood flow, which can decrease function and even cause the organs to die.

Causes, Incidence, and Risk Factors

Peripheral Artery Disease is caused by arteriosclerosis, commonly referred to as"hardening of the arteries." This problem occurs when fat and other debris known as plaque builds up on the walls of your arteries. This causes the arteries to become narrower and they also become stiffer and cannot widen to allow greater blood flow when needed. As a result, when the muscles of your legs are working harder they cannot get enough blood, oxygen and other nutrients. In many patients, there may not be enough blood and oxygen, even when the muscles are resting. This can lead to pain and even gangrene (death of tissues).

PAD is common and usually affects people over age 50. Risk factors include:

  • Abnormal cholesterol (dylipidemia)
  • Diabetes
  • Heart disease (coronary artery disease)
  • High blood pressure
  • Kidney disease
  • SmokingStroke

Symptoms and Signs

The classic symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms usually appear during walking or exercise and go away after several minutes of rest.

  • At first, these symptoms may appear only when you walk uphill, walk faster, or walk for longer distances.
  • Slowly, these symptoms come on more quickly and with less exercise. Your legs or feet may feel numb when you are at rest. The legs also may feel cool to the touch, and the skin may appear pale.

 When peripheral artery disease becomes severe, you may have:

  • Erectile dysfunction/impotence
  • Pain at rest
  • Pain or tingling in the feet or toes, even the weight of clothes or bed sheets can be painful
  • Pain that is worse when the leg is elevated and improves when you dangle your legs down
  • Ulcers that do not heal

During an examination, the health care provider may find:

  • A whooshing sound with the stethoscope over the artery (arterial bruits)
  • Decreased blood pressure in the affected limb
  • Loss of hair on the legs or feet
  • Weak or absent pulses in the limb

When PAD is more severe, findings may include:

  • Calf muscles that shrink (wither)
  • Hair loss over the toes and feet
  • Painful, non-bleeding ulcers on the feet or toes (usually black) that are slow to heal
  • Paleness of the skin or blue color in the toes or foot
  • Shiny, tight skin
  • Thick toenails

Blood tests may show abnormal cholesterol, diabetes or a condition known as homocysteinemia.

Diagnostics:

  • Physiologic testing (PVRs and ABI's) – non-invasive, low cost and pain free
  • Arterial and Venous Doppler Ultrasound - structural testing of the vessels
  • Various Angiograms, minimally invasive using small needles and catheters, identifies lesions that may need intervention
  • CTAs (Computer Tomography angiograms) gives detailed 3 dimensional picture and helps to monitor and plan
  • MRAs (Magnetic Resonance Angiograms) detailed picture of vessels, good for monitoring

Treatments/Interventions:

  • Abdominal Aortic Aneurysm Stent Graft (Minimally Invasive)
  • Peripheral and Visceral Artery Balloon Angioplasty
  • Peripheral and Visceral Artery Stenting
  • Uterine Artery Embolization for Fibroids (UAE/UFE)
  • Peripheral Arterial Bypass Surgery
  • Carotid Endarterectomy for Carotid Stenosis and Strokes
  • Inferior Vena Cava Filter
  • Permanent Dialysis Access: AV-Fistula and AV-Graft
  • Vascular Access: Catheters, Infusion Ports, PICC Lines