Peripheral Arterial Disease (PAD)

The symptoms of PAD are similar to several other conditions. A vascular surgeon is appropriately trained to recognize and differentiate PAD from other vascular diseases.
Some of these conditions include:

• Peripheral neuropathy from diabetes or back problems
• Sciatic nerve problems
• Lumbar disc disease of the lower back
• Arthritis of the joints
• Gout of the joints of the hands or feet
• Muscular and skeletal pain
• Varicose vein disease

The treatments for these conditions are very different, and patients need a proper evaluation by a vascular surgeon to confirm the diagnosis.

The type of doctor best suited to treat this condition is a peripheral vascular surgeon who is specifically trained in the management of blood vessels outside of the heart and brain. A vascular surgeon knows how to use medication, minimally invasive procedures or even open surgery to achieve a quality outcome for the patient. 

If a patient's primary care provider or cardiologist suspects they have PAD, patients should consider requesting a referral to a vascular surgeon for evaluation of all PAD treatment options.

The most common risk factors for peripheral arterial disease include:

• Smoking or other tobacco use (or history of smoking)
• High blood pressure (hypertension)
• Diabetes (Type 1 or 2)
• High cholesterol (hyperlipidemia)
• Age over 50
• Obesity 
• Family history of heart disease (coronary artery disease), PAD or stroke

These same risk factors can also lead to heart artery blockages, stroke (brain attack) and kidney failure (possibly dialysis). These conditions can contribute to atherosclerosis or a hardening of the arteries. Buildup on the inside layer of the artery can gradually increase until the artery is severely narrowed or even completely blocked. 

PAD is more common than people may think. Many people have risk factors for PAD, like smoking, high blood pressure and diabetes, but may not have developed PAD symptoms yet. As people age, they are also more likely to develop PAD. It is estimated that as many as 20% of the population over the age of 50 may have some degree of PAD.PAD is more common than people may think. Many people have risk factors for PAD, like smoking, high blood pressure and diabetes, but may not have developed PAD symptoms yet. As people age, they are also more likely to develop PAD. It is estimated that as many as 20% of the population over the age of 50 may have some degree of PAD.

Diagnosing PAD always starts with getting a good medical history from the patient. A vascular physical examination is also essential, during which your doctor will check the pulses in the legs and arms. 
Your doctor will likely perform painless tests such as an ankle-brachial index (ABI) and vascular ultrasound.

• ABI involves putting a blood pressure cuff on the ankle, arm and toes to determine how much blood is getting to the feet and toes. It takes only a few minutes to complete.
• A vascular ultrasound involves applying an ultrasound machine and gel to the skin, which allows your medical provider to listen and look at the blood vessels (arteries). Using the ultrasound machine, your doctor can determine if blood is flowing through your arteries properly. This is a painless test performed by a specially trained vascular ultrasound technician.

Other possible tests include:

• CT angiography: A noninvasive test that uses X-rays and a contrast agent (dye) to visualize the blood vessels in the arteries in your abdomen, pelvis and legs.
• Angiography: A minimally invasive procedure where the vascular surgeon places contrast dye into the arteries and takes images (X-rays) to view the blood vessels in the abdomen, pelvis, legs, feet, chest and arms. This is a specialized procedure that a properly trained vascular surgeon should perform.

Treatment for PAD should be individualized based on the severity of the patient's symptoms, the location of the blockage, and the extent of any pain or wounds, as determined by the vascular surgeon.
PAD treatment may involve: 

• • Lifestyle changes. Sometimes, the following lifestyle changes are sufficient to improve symptoms or reduce risk: 
  • Quitting smoking (or using tobacco products). Smoking is the primary risk factor for PAD. It is essential to avoid secondhand smoke as well. For basic information about how to quit smoking, call the National Cancer Institute's Smoking Quitline at 1-877-44U-QUIT (1-877-448-7848).
  • oxercising or walking regularly to help keep blood vessels working properly. Regular exercise usually means continued activity for 30 or more minutes three to five times per week. Your doctor should confirm that it is safe to begin an exercise program.
  • Diet modifications, including adopting a heart-healthy or Mediterranean-style diet. Your primary physician or a nutrition expert should be consulted to ensure your diet plan is appropriate. 
  • Weight management. Maintaining a healthy weight helps reduce your risk of vascular disease and other conditions, including diabetes and high blood pressure. Patients should work with their primary physician to make a safe and effective plan.
  • Stress management
• • Medications. The following medicines may be prescribed by your primary physician or vascular surgeon:
  • Antiplatelet medications like aspirin or clopidogrel may be prescribed to help stop platelets in the blood from sticking to damaged artery walls.
  • Cilastazol may improve symptoms that patients experience while walking.
  • Statins can help to lower cholesterol and certain fats in the blood.
  • Blood pressure medications may be prescribed to lower a patient's blood pressure and keep it at a healthy level.
• All medications may have side effects and should only be prescribed by a medical professional. It is important for the patient to understand what medications they are taking and their potential benefits. Patients should also work closely with their physicians to continuously monitor their medications.
• Minimally invasive procedures. Your vascular surgeon may perform a minimally invasive (endovascular) procedure to treat blocked arteries. For example, an angiogram is usually done with light sedation anesthesia (often called "twilight"). It involves putting a small tube ("sheath") into the artery, taking X-ray images with contrast dye to identify the blockage, crossing the blockage with a wire, and then treating it with a balloon or other small device designed to clear the plaque and open the blockage. Most of these procedures can be performed as an outpatient, meaning they do not require a hospital stay. 
• Open vascular surgery (bypass surgery). Open surgery is sometimes needed when a blockage is too extensive for an endovascular procedure to be effective. This could be due to the location of the blockage, the length of it or the severity of the symptoms. Your vascular surgeon will determine if this type of surgery is needed. Open surgery usually requires general anesthesia and a stay in the hospital. In this approach, the surgeon takes an accessory vein from the body and makes a new pathway for the blood to get past a blockage. This type of surgery can be performed safely by a vascular surgeon.
• Hybrid procedures. Vascular surgeons are trained to perform both endovascular and open surgery. Sometimes, a "hybrid" procedure, where both approaches are combined to manage the artery blockage, is needed. Your vascular surgeon will advise when this is the preferred approach.

While PAD is not reversible, it can be effectively managed. The goal of PAD treatment is to reduce symptoms like leg pain and cramping. When a patient has gangrene or an open wound, another treatment goal is to deliver adequate blood supply to allow wound healing. This can ultimately help save a limb and prevent amputation. 
Patients should also not wait until it is too late to adopt healthy lifestyle habits. They should quit smoking, lose weight, manage diabetes and blood pressure, eat properly and exercise before they develop symptoms of PAD.
PAD is a serious condition, but if recognized early and treated by a vascular surgeon, it can be effectively managed.