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Peripheral Arterial Disease (PAD)

Peripheral Arterial Disease (PAD), also known as Peripheral Vascular Disease, is a circulatory condition affecting the arteries that carry blood to the legs and feet. Arteries are narrowed due to plaque buildup, which reduces blood flow to the legs and feet. PAD increases one’s risk of heart attack or stroke. If the disease progresses, blood vessels can narrow to dangerous levels, causing pain, ulcers and gangrene. This life-threatening stage of PAD is called critical limb ischemia (CLI). If gone untreated, the affected limb may need to be amputated.

Peripheral Artery Disease diagram (PAD)

Risk factors for PAD include:

  • History of smoking
  • Having one or more chronic diseases, such as diabetes
  • High cholesterol
  • Family history of heart attack stroke, heart disease or peripheral vascular disease
  • High blood pressure
  • Age (1 in 10 people over age 65 have PAD)
  • Postmenopausal women
  • Male gender
  • Coronary artery disease
  • Overweight
  • Physical inactivity
  • Smoking or use of tobacco products

Those who smoke or have diabetes have the highest risk of complications because these factors also cause impaired blood flow.

Possible Symptoms:

  • Pain when walking
  • Cold feet or toes
  • Dry, discolored skin on feet
  • Foot pain that worsens at night and improves when dangling the leg
  • Pain in calves and thighs when walking
  • Numbness in the legs
  • Foot sores that won’t heal
  • Hair loss on the legs

Diagnosing PAD

Not everyone with PAD has symptoms, and sometimes symptoms may be undiagnosed. If you or a loved one is experiencing any of these risk factors, talk to your doctor. There is a simple test called an ankle-brachial index (ABI) that compares the blood pressure in your ankle to that in your arm. If the pressure is lower in your ankle than in your arm, it’s possible that you have PAD. Other tests to further diagnose PAD include:

  • Pulse volume recording (PVR) - A noninvasive vascular test in which blood pressure cuffs are used to obtain information about arterial blood flow in the arms and legs
  • CT Angiography (CTA) - A dye is injected into the artery to show blood flow, allowing doctors to see blockages on a CT scan to determine if there is disease
Peripheral Arterial Disease (PAD) photo

Treatments

There are a variety of treatments that are used to manage PAD.

  • Medications: can help improve blood flow, reducing the cardiovascular risk and/or symptoms associated with PAD. They can control blood pressure, cholesterol, diabetes and block platelet activity (blood clotting).
  • Lifestyle and dietary changes
  • Quitting smoking can help reduce the severity of PAD. All inpatient and outpatient services include smoking cessation education. Massachusetts residents may enroll in the Quitworks smoking intervention program. More info on this program is available by calling 1-800-TRY-TO-STOP (1-800-879-8678)

Non-surgical, minimally invasive procedures to treat PAD

Endovascular treatments through the veins in the legs to unblock and repair blood vessels. By inserting narrow plastic tubes, or catheters, into the blood vessels, our specialists are able to access sites with cholesterol plaque blockage with minimal downtime to patient.

  • Angioplasty – A balloon-tipped catheter is placed into the artery and advanced to the obstructed area. The balloon is inflated to expand the blockage, and then deflated and retrieved, widening the narrowed artery
  • Stenting – Often performed during angioplasty, this technique inserts a mesh-like device at the point of the blockage and is expanded permanently into the vessel wall, propping open then blockage
  • Atherectomy – A specialized catheter with directable blades, laser tip or polishing drill is advanced through the plaque repeatedly, removing plaque debris from the vessel wall to restore flow in the channel

Surgical procedures for advanced disease

  • Endarterectomy – Through a surgical incision, the blocked artery is exposed and opened. The plaque is then removed, resulting in a widening of the blocked artery
  • Surgical bypass – Blood flow is rerouted around the blocked blood vessel by attaching a conduit (either a vein harvested from the body or a prosthetic tube) above and below the point of obstruction

To learn more about our vascular specialists that treat PAD, visit their profiles below:

All endovascular and surgical procedures are performed in state-of-the-art angiography suites and operating rooms at the Lowell General Hospital Main Campus. Our vascular specialists work closely with the vascular surgeons at Tufts Medical Center to provide the latest treatments for PAD to allow patients to stay close to home.

Kirk MacNaught

Kirk J. MacNaught MD, FACC

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