Peripheral Arterial Disease

What is Peripheral Arterial Disease (PAD)?

Your arteries carry fresh, oxygenated blood from your heart, while your veins carry the old blood back to your heart and lungs. But as you age, one or more of your artery linings may change from being smooth to becoming irregular as plaque, a buildup of fat, cholesterol or calcium, occurs. When this happens in the arteries outside of your heart or brain, especially in the legs and arms, it’s called peripheral arterial disease (PAD), also known as atherosclerosis or “hardening of the arteries.”

What Causes PAD?

Peripheral arterial disease (PAD) — also known as peripheral vascular disease, atherosclerosis or hardening of the arteries — is a disorder that occurs in the arteries of the circulatory system. Arteries are the blood vessels that carry oxygen and nutrient-rich blood from the heart to all areas of the body. PAD occurs in the arteries that carry blood to the arms and legs when there is a large buildup of plaque, pieces of plaque or blood clot that breaks loose, causing blockage further down the arterial system.

Who Is At Increased Risk for PAD?

The rate at which PAD progresses varies with each individual and depends on many factors, including where in the body the plaque has formed and the person’s overall health. If you have any of the following, a Duplex Doppler Ultrasound Scan can be performed to diagnose PAD. This simple, painless test does not involve needles or dye and is performed in our Vascular Lab.

  • High cholesterol levels
  • High triglyceride levels
  • High blood pressure (hypertension) 
  • Diabetes
  • Family history of PAD or heart disease
  • Obesity
  • Sedentary lifestyle and lack of exercise
  • Previous stroke
  • Current or previous smoker

What are the signs and symptoms PAD?

In most patients, PAD is silent and exhibits no symptoms. However, when your arteries to the legs get significantly narrowed or blocked, certain telltale symptoms will occur. The first and most important symptom is referred to as claudication. This condition causes a cramping pain, dull ache, or sense of tiredness in the calves or buttocks when you walk a specific distance, but the pain goes away when you stop walking and rest. It comes on again when you resume walking usually after one reaches the same distance.

When this blockage becomes severe, pain may occur, even at rest. This usually is noticed at night when you lie down to go to sleep. In bed, we no longer have gravity helping the blood to travel to the feet and so they start to ache. Patients will often remark that the pain eases somewhat when they get out of bed and stand. This is an important symptom, since it implies very severe impairment to your blood flow. If untreated, gangrene or loss of blood flow to the toes or feet can eventually result. Similarly, cuts or scrapes may not heal and may also lead to loss of part of the limb.
When our vascular surgeons examine patients with PAD, certain findings may be discovered including:

  • Absent pulses in the foot or leg
  • A noise in the artery caused by a turbulent blood flow, called a bruit
  • A cool temperature in the foot or leg
  • A pale color when the foot is elevated
  • Decreased hair or tissue fat
  • Open sores or black areas of gangrene.

What Tests Are Available for Peripheral Arterial Disease?

Simple, painless tests at DVVI can be performed to diagnose PAD. These tests don’t involve needles or dye and are usually performed in our Vascular Lab. It’s also important to note that your test will be performed in a lab that is accredited by the Intersocietal Commission on the Accreditation of Vascular labs (ICAVL), as ours is.

Duplex Doppler Ultrasound Scan: To get a picture of where your blockage is, the latest in  ultrasound technology is used to painlessly and non-invasively produce pictures showing the blood vessels and their flow. This is a process similar to radar.

Magnetic Resonance Scans (MRI and MRA): This technology which relies upon highly powered magnets to align water molecules in the body tissues can provide a road map of the arteries. It is a painless and fairly rapid form of assessment especially on the latest machines, but is noisy and some patients feel hemmed in or claustrophobic by the procedure. These tests are expensive, but completely safe. However, they can’t be used in patients who have steel implants such as pacemakers. MRA is becoming an increasingly popular imaging technique for blood vessels. Some recent reports indicate there is a risk of kidney damage in some patients from the use of a gadolinium contrast medium.

Arteriograms: When some form of invasive treatment is planned, an arteriogram may be performed. An arteriogram is an outpatient procedure that involves injection of dye into the blood vessels of the lower extremities. Arteriograms can diagnose peripheral arterial disease with great accuracy and treatment of the blocked artery can be performed in the same setting.

How is PAD Treated by Desert Vein and Vascular Specialists?

An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel. You may need this procedure if your arteries become too narrowed or blocked from plaque inside the artery walls. If arteries are blocked, blood cannot get through to nourish the tissues, causing the muscles of the lower extremities to cramp and lose strength.

The goal of treatment is to eliminate the build-up of plaque in your arteries. With atherectomy, the catheter is inserted into the artery through a small puncture in the artery, and it is performed under local anesthesia. The catheter is designed to collect the removed plaque in a chamber in the tip, which allows removal of the plaque as the device is removed from the artery. (watch this video to see how this procedure works).

The process can be repeated at the time the treatment is performed to remove a significant amount of disease from the artery, thus eliminating a blockage from atherosclerotic disease.

Where is the atherectomy procedure performed?

This procedure is performed in the hospital surgical, interventional, or catheterization suite by one of our trained vascular surgeons.

What are the risks and potential complications of the artherectomy procedure?

Your Desert Vein and Vascular Specialist will discuss the specific risks and potential benefits of the procedure with you. This procedure is not ideal for everyone. Each patient is evaluated, and treatment will be individualized on a case-by-case basis.

Atherectomy is a safe procedure and complications are rare. In any surgery, there is risk of complication such as embolization (the dislodgement of debris that blocks the arteries in the lower part of the leg), perforation, and possible re-blockage of the artery (restenosis) that may occur later, especially in patients who smoke cigarettes.

Call us now to learn more or to schedule a consultation: (760) 568-3461

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Desert Vein Institute

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Vein and Vascular
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71780 San Jacinto Drive
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Rancho Mirage, CA 92270
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Tel: 760.568.3461