Peripheral Artery Disease
Peripheral artery disease, also known as PAD, is a common vascular condition involving a buildup of plaque within the peripheral arteries of the limbs, usually the legs and feet. Plaque is an accumulation of fat, cholesterol, calcium and other substances in the blood. The buildup of plaque can severely narrow or block the arteries and limit the flow of oxygen-rich blood to the body. PAD may be a symptom of atherosclerosis, a specific form of arteriosclerosis, which leads to a more widespread occurrence of plaque buildup in arteries.
Causes of PAD
There are many causative factors involved in the development of PAD. Causes or risk factors for PAD may include the following:
- Increasing age
- Lack of exercise
- High blood pressure
- High cholesterol
- Family history of PAD or other circulatory problems
- High levels of homocysteine, a protein
More uncommon causes of PAD may include limb injury, anomalies of anatomy, blood vessel inflammation or radiation exposure.
Symptoms of PAD
Patients with PAD may be asymptomatic. For those who experience symptoms, those symptoms may vary in kind or severity from patient to patient. Symptoms in the affected area may include:
- Claudication, pain or cramping when walking
- Numbness or weakness
- Sores on the skin that don't heal
- Discoloration or change of texture of the skin
- Hair loss
- Weak pulse or coldness to the touch
- Erectile dysfunction in men
If peripheral artery disease progresses, pain may even occur while a person is resting, known as ischemic rest pain. It may be intense enough to disrupt sleep. Hanging one's legs over the edge of the bed or walking around the room may temporarily relieve the pain.
Diagnosis of PAD
Peripheral artery disease may be effectively diagnosed using the following:
- Physical examination
- Ankle-brachial index (ABI)
- Doppler ultrasound
- Blood tests
Treatment of PAD
Treatment for peripheral artery disease is a two-pronged effort, designed not only to relieve symptoms, but to stop the progression of vascular disease. It is important to get atherosclerosis under control since this disease puts the patient at risk for heart attack or stroke. Treatments for PAD may include any and all of the following:
Before any additional medical treatment is undertaken, patients are advised to make changes in their habits which may be lifesaving. The most important of these is for patients who smoke to stop smoking. Other beneficial changes include losing weight, eating a healthier diet, making sure to get regular exercise and alleviating stress wherever possible. Particular exercise programs to assist in treating PAD are sometimes recommended.
Several types of medications may be helpful in treating PAD. These may include:
- Cholesterol-lowering drugs known as statins
- Medications to lower blood pressure
- Medications to control glucose levels in patients with diabetes
- Anticoagulants to increase blood flow
- Medications to relieve symptoms such as claudication
- Drugs injected into the artery to dissolve clots, or thrombolytics
In some cases, surgical interventions may be necessary to treat PAD, including angioplasty to reopen the blocked artery and increase blood flow or bypass surgery to circumvent the blocked artery. The latter may be accomplished using either synthetic materials or a blood vessel from another part of the body.
Interventional radiologists at MISS use a variety of minimally invasive procedures to treat Peripheral Artery Disease (PAD). PAD occurs when there is a buildup of plaque in the arteries, reducing blood flow to the limbs, usually the legs. Minimally invasive procedures are preferred because they are generally safer, involve smaller incisions, and have shorter recovery times compared to traditional open surgeries. Here are some common minimally invasive procedures used by interventional radiologists to treat PAD:
Angioplasty: During an angioplasty, a catheter with a balloon at its tip is threaded through the arteries to the site of the blockage. The balloon is inflated to compress the plaque against the artery walls, widening the artery and restoring blood flow.
Stent Placement: In many cases, after angioplasty, a stent (a small mesh tube) is placed at the site of the blockage. The stent acts as a scaffold, keeping the artery open and improving blood flow.
Atherectomy: Atherectomy involves using a catheter with a sharp blade or laser at its tip to cut or vaporize the plaque. This helps in removing the blockage and improving blood flow.
Thrombolytic Therapy: In cases where a blood clot is causing the blockage, interventional radiologists might use thrombolytic drugs that dissolve the clot, restoring blood flow. This can be done through a catheter directly at the site of the clot.
Bypass Grafting: In more severe cases, a bypass graft might be necessary. In this procedure, a graft (a vessel from another part of the body or a synthetic tube) is used to create a new pathway for blood to flow around the blocked artery, restoring blood flow to the limbs.
Cryoplasty: This is a procedure where a balloon catheter is filled with nitrous oxide, which is then frozen. The frozen balloon is inflated inside the blocked artery, cracking the plaque and opening the artery.
Laser Atherectomy: Laser beams are used to vaporize or break down the plaque in the arteries, allowing the removal of blockages and restoration of blood flow.
These procedures are often guided by imaging techniques like fluoroscopy, ultrasound, or angiography, allowing the interventional radiologist to see the inside of the blood vessels and perform the necessary treatments with precision and accuracy. The choice of procedure depends on the location and severity of the blockage, as well as the overall health of the patient.
Risks of Surgery for PAD
While surgeries for PAD are generally considered safe, there are always risks involved in any surgical procedure. In additions to the risks inherent in any surgical procedure which may include allergic reactions to anesthesia or medications, breathing problems and the possibility of infection, angioplasty and bypass for PAD may include the following complications, all of which are greater in older patients:
- Heart attack
- Incapacity of blood vessels
- Impermanence of the bypass
- Leg problems
There is often swelling in the leg that has been operated on. In some cases, the swelling may be more severe. Such swelling may subside with time, but mild permanent swelling is a common result of bypass surgery. Thrombophlebitis in the affected limb is also possible.
Recovery from Surgery for PAD
After a surgical procedure for PAD, the wound in the groin where the catheter was inserted must be tended. Light walking is encouraged, but strenuous exercise must be avoided for a period recommended by the doctor. It is important for patients recovering from angioplasty for PAD to maintain a healthy lifestyle and to take prescribed medications. In patients who do not make the necessary changes, restenosis, or recurring blockage of arteries, is common.