Peripheral Artery/Vascular Disease

PAD causes aches, heaviness, numbness, burning or cramping in your calves, thighs, hips, buttocks or feet that occurs while walking or climbing stairs. The discomfort gets better after you rest.

Because PAD is such a serious and progressive disease, it's important to know the difference between pain caused by arthritis and symptoms that indicate blocked blood flow.

Although arthritis pain makes itself known, PAD might not cause symptoms. Check with your doctor about PAD testing if you're older than 70, or older than 50 with a history of smoking or diabetes. People younger than 50 with diabetes and other risk factors for heart disease should also talk with a doctor about their risk for PAD.

Who is at Risk?

The National Heart, Lung and Blood Institute estimates about 1 in 20 adults over the age of 50 may have PAD, and the condition becomes more common in older age groups. 

African-Americans have a higher risk for PAD than other ethnic groups.

Men have a higher risk for PAD than women.

Other factors that increase the risk for PAD are age, smoking, diabetes, high blood pressure, obesity, high cholesterol, heart disease and stroke. A family history of these conditions may also increase risk.

Causes

The most common cause of PAD is atherosclerosis. Atherosclerosis is a condition in which fatty deposits build up in arteries, the blood vessels that carry oxygen-rich blood from the heart to all parts of the body. Over time, these fatty deposits eventually block blood flow to leg arteries, preventing oxygen from reaching the muscles of the legs. This causes cramping and pain when walking because the muscles need more oxygen when they are working. If the blockage is severe, it can prevent sufficient blood from reaching the foot or leg even when the muscles aren't working and lead to gangrene or possibly amputation.

The exact cause of atherosclerosis is not known, but smoking, high cholesterol, high blood pressure and diabetes all contribute to its development. Atherosclerosis affects all the arteries in the body, not just the ones feeding the legs. This means that PAD is a warning sign that arteries in the heart and brain may be blocked, increasing your chance of heart attack and stroke. 

Signs and Symptoms

PAD starts slowly. You may not notice it because mild PAD may not cause symptoms. Discomfort can occur in the lower legs, thighs, hips, buttocks or feet. In addition to pain, other common sensations are heaviness, tingling or fatigue. Rest usually helps, but raising your legs – as when you lie in bed – might make the discomfort worse. Other warning signs include:

• The skin on your leg turns pale or bluish when you elevate it.
• Your foot turns a dusky red when you stand or sit.
• The hair on your foot stops growing, or your toenails stop growing.
• You have sores on your toes, feet or legs that heal slowly or not at all.

See your doctor if you have any of these symptoms. PAD can be diagnosed with a simple test called an ankle-brachial index. This test measures blood flow by comparing blood pressure in your arms with blood pressure in your legs. Your doctor might also use ultrasound or angiography to diagnose PAD.

Treatment depends on the severity of the blockage in blood flow. You might need to change your lifestyle by quitting smoking, controlling cholesterol, lowering high blood pressure or managing diabetes. You may need to take medication to control cholesterol, blood pressure, and diabetes or to thin your blood.

Sometimes people with PAD need surgery to bypass a blockage and create a new path for blood flow. Angioplasty, a procedure in which the blockage is flattened to make the artery opening wider, is another possible treatment.

Our vascular surgery team has nationally recognized expertise in endovascular treatment of abdominal aortic aneurysms. Our interventional cardiologists’ capabilities include endovascular treatment of renal, iliac and femoral occlusions; use of atherectomy devices; and use of specialized intravascular ultrasound-guided techniques for crossing totally obstructed segments.

The group also offers endovascular treatment of carotid and subclavian disease using the latest technologies for cerebral protection. The vascular surgery team was also part of the largest FDA-mandated national registry for carotid stenting, which ensured both the appropriateness and the high quality of carotid procedures across the country.

Our surgery and interventional cardiology specialists have a long track record in successful treatment of renovascular disease. Recently, UK was chosen as one of a select group of centers that will participate in renal denervation research, which offers a unique and novel therapy for patients with resistant hypertension. UK is the only center that offers this opportunity in the state.

In addition to complex procedures, our team of experts focuses on secondary prevention efforts to try to keep PAD from getting worse in patients who have been diagnosed. The team focuses on smoking cessation, lipid lowering and walking programs for those patients after successful surgical or endovascular therapy.