Peripheral Artery Disease (PAD)

Peripheral vascular disease (PVD) refers to diseases of blood vessels located outside of the heart or brain. When blood vessels in the arms, legs, or organs are narrowed, the blood flow required for ordinary function is restricted.

The most common peripheral vascular disease (PVD) is peripheral artery disease (PAD), which develops when plaque clogs or narrows arteries that deliver blood to the arms, legs and internal organs such as the stomach or kidneys. As a result, extremities (usually the legs) don't get enough blood. Consider PAD a warning that hard fat and calcium buildup also may curb blood flow to the heart and brain.

Early detection and treatment can prevent heart attacks, strokes, mini-strokes (or transient ischemia, which is lack of oxygen to the brain), leg ischemia and possible amputation. Patients diagnosed with coronary heart disease have a one in three chance of blocked leg arteries, according to the National Heart, Lung and Blood Institute (NHLBI).

Some causes of PAD can be controlled, including obesity, diabetes, smoking, hypertension and high cholesterol. Two cannot: age and ethnicity. The disease is more common in African-Americans than any other racial or ethnic group, reports the NHLBI.

About one in 20 individuals exceeding age 60 and one in three diabetics over age 50 have the disease.

But the greatest risk is smoking, which raises the chance of PAD four-fold and causes symptoms a decade earlier than in those who have never smoked, according to the NHLBI.

Initial symptoms include leg pain when walking, cramping or tiredness in the extremities, leg numbness or weakness, cold legs or feet, sores on toes, legs or feel that won't heal, or hair loss on feet and legs.

But not everyone has symptoms. Anyone over age 70 as well as smokers and diabetics over 50 should be screened for PAD.

If the blood pulse at ankles is feeble, physicians affiliated with Memorial Hermann will check for PAD with state-of-the-art imaging tools. Blood tests can reveal risk factors for the ailment, such as high cholesterol, blood pressure or blood sugars.

A simple test called an ankle-brachial index (ABI) – sometimes performed before and after walking on a treadmill – compares blood pressure in the patient’s arms and ankles.

Patients also may need advanced tests to check blood flow and artery clogging, including Doppler ultrasound, CT scans (computerized tomography) or angiography (an X-ray test in which a catheter is threaded into an artery up from the groin). Or it may be or a combination of such tests, such as CT angiography or MRA (magnetic resonance angiography, a form of magnetic resonance imaging using magnetic and radio wave energy instead of X-rays to take pictures of blood vessels). An arteriogram – a road map of the vessels – can find exactly where and how gravely arteries are blocked. After an opaque dye is injected via needle into an artery, an X-ray is taken.

To reduce underlying plaque buildup, patients may need to take medicines that lower blood pressure and cholesterol. It’s also vital to boost activity and consumption of fruits and vegetables, while cutting calories and levels of salt and fat (total, saturated and trans fats). These measures also help drop chances of hypertension, high cholesterol and diabetes.

Patients must quit smoking. Even smoking just one or two cigarettes daily interferes with PAD treatments, the NHLBI says.

The extent of blockage determines how Memorial Hermann-affiliated physicians restore blood flow. They team with McGovern Medical School at UTHealth faculty members to combine the expertise of cardiothoracic and vascular surgeons and other specialists to deliver the best results – with reduced pain, blood loss and mortality, faster recoveries and shorter hospital stays.

The possibilities range from minimally invasive procedures to open bypass.

In less severe cases, obstructions may be shaved from the arterial wall with a laser or a tiny, rotating knife inside a catheter. Blockages are removed through the catheter or washed away in the bloodstream. A stent – a small mesh tube sometimes coated with medicine – may be inserted to thwart future blockages. This is known as atherectomy.

Balloon angioplasty is commonly used for blockages in larger vessels, with stents again possible. During this procedure, a catheter (thin tube) with a balloon at the tip is inserted into a blocked artery. The balloon is then inflated, which pushes plaque outward against the artery wall. This widens the artery and restores blood flow.

An open bypass may be needed if blood flow to a limb is nearly blocked. Physicians may use a blood vessel from another part of the body or a man-made tube to route blood around the clogged part, thus allowing flow around the blockage. PAD isn’t cured, but blood flow improves.