Peripheral artery disease, or PAD, is a common cause of leg pain.

Peripheral artery disease, or PAD, is a common cause of leg pain. It is a slow progression of arterial narrowing and blockages brought on by changes in the walls of the arteries. This is a process called atherosclerosis. It has several risk factors, including high blood pressure, high cholesterol, diabetes, smoking, and kidney disease.

Artery Disease Symptoms

In atherosclerosis, the walls of the arteries become thicker due to cholesterol or fatty plaques and other debris related to chronic inflammation. As the arteries narrow, this will eventually cause problems due to inadequate blood flow distally. In its early stages, this may appear only as hair loss or slow-growing brittle nails. Later in the disease process, patients will often feel cramping pain after activity in the hip, buttocks or leg. This is called claudication, a hallmark of PAD. Other symptoms include numbness, tightness or weakness.

Critical Limb Ischemia

A small percentage of patients with claudication will eventually develop the most severe form of PAD, critical limb ischemia (CLI). In this advanced stage of PAD, the affected area is at risk for amputation, and treatment is necessary. CLI is characterized by nonhealing ulcers, gangrene, pain at rest and sometimes infection. Most of the patients who undergo amputation are not evaluated by a vascular specialist, such as an interventional radiologist. Undergoing a major amputation is a strong risk factor for mortality. In fact, about half of the patients who undergo amputation are permanently disabled and never walk again.

Treatment

Early on in the process of atherosclerosis, before the onset of symptoms, the disease is potentially reversible with medicine and lifestyle modifications. Once it has progressed to claudication, the disease is typically irreversible but can be effectively managed with lifestyle modifications. When the claudication is severe, or the disease progresses to CLI, treatment is often necessary. In the past, surgery was the only option, but newer minimally invasive surgical alternatives pioneered by interventional radiologists have revolutionized the treatment process.

The minimally invasive options are numerous. The most basic treatment is using small tubular balloons to open up the narrowed arteries, which is called angioplasty. A tubular metallic mesh implant called a stent can also be used to open up a blocked artery. There are also various devices that can remove segments of plaques by vaporizing or removing the plaques. Patients will first undergo an x-ray dye study called an angiogram to diagnose areas of arterial blockage or narrowing. If appropriate, one of the treatments can be performed. These are all able to be done in an outpatient setting under sedation. Recovery is only 2 days.

At Summit IR, we will evaluate your problems and find the right treatment for you, whether it be medicine, lifestyle modifications, or a minimally invasive procedure. Contact us today to learn more.