Peripheral Arterial Disease (PAD)

What is Peripheral Artery Disease?

Peripheral artery disease (PAD) is the narrowing of the arteries that carry blood away from the heart. The leading cause of PAD is plaque buildup, called atherosclerosis. It is most common in the legs and feet, but people can also develop it in their arms. It can lead to skin changes, leg pain, wounds that don’t heal, and poor muscle perfusion.

Plaque builds on the artery wall, causing the artery to become hardened and more narrow. The plaque is mostly fat and cholesterol. There is a reduction of oxygenated blood flow because of the blockage in the artery.

Who suffers most? PAD Health Disparities

Black and Hispanic Americans experience PAD and its devastating consequences more frequently.

• Black people are two times more likely to suffer from PAD and up to four times more likely to undergo an amputation.
• Hispanic Americans present with more progressive PAD, leading to worse outcomes, including greater risk of amputation.

What are the treatment options for Peripheral Artery Disease?

While not curable, PAD is highly treatable condition, often without resorting to major surgical interventions. The optimal treatment approach varies based on the patient and the disease’s severity. The following treatment modalities represent common options for individuals grappling with PAD:

Lifestyle Modifications

These modifications are typically recommended for all PAD patients. In many instances, adhering to these lifestyle changes proves sufficient for noticeable improvements. However, some cases may necessitate additional procedures. Post-procedure, patients should continue lifestyle adjustments to minimize the risk of recurrence. Patients with PAD are advised to:

• Maintain a health-conscious, low-sodium diet
• Take aspirin as directed by their physician
• Adhere to prescribed medications for blood pressure, diabetes, or cholesterol
• Cease smoking
• Engage in a more active lifestyle, such as a walking program

Angiogram & Endovascular Intervention

Should symptoms persist despite lifestyle changes, the next step involves an angiogram with endovascular interventions. During an angiogram, a thin catheter is inserted into a leg artery, facilitating the injection of a contrast dye for X-ray imaging. This procedure enables the doctor to identify areas of optimal blood flow and blockages impeding circulation. The choice of minimally-invasive approach during an angiogram depends on factors such as blockage location, size, and quantity. Potential treatments during an angiogram include:

• Angioplasty: A small balloon is inflated in the blocked area, flattening plaque and restoring blood flow, followed by balloon removal.
• Atherectomy: The physician removes plaque from artery walls, enhancing blood flow.
• Stent Placement: An expandable mesh-like tube is positioned in the artery to keep it open.

Peripheral Artery Bypass

A Peripheral Artery Bypass is a surgical procedure performed to address significant blockages or narrowing in the peripheral arteries, typically in the legs. During the procedure, a vascular surgeon creates a detour or bypass around the blocked or narrowed artery using a graft.

The graft is typically a segment of a vein taken from another part of the patient’s body, such as the leg or an artificial graft material. This graft is then attached above and below the diseased portion of the artery, allowing blood to flow freely through the new pathway, bypassing the obstructed segment.

Peripheral Artery Bypass is considered when other treatment options, such as lifestyle modifications, medications, or less invasive procedures like angioplasty and stent placement, are not effective in restoring adequate blood flow. It is a more extensive surgical intervention and is usually reserved for cases of advanced peripheral artery disease where multiple or long arterial segments are affected. The goal of the procedure is to alleviate symptoms, improve blood circulation, and prevent complications associated with reduced blood flow, such as pain, impaired mobility, or non-healing wounds.