Peripheral Arterial Disease (PAD)/Peripheral Vascular Disease (PVD)
Peripheral arterial disease (PAD) occurs when the arteries narrow due to atherosclerosis (hardening of the arteries). When symptoms are present, the most common are cramping, discomfort, or tiredness in the leg muscles while walking or exercising.
PAD is a slow and progressive circulation disorder. Areas affected by PAD, such as the arms and legs, may not receive adequate blood flow. If left untreated, in severe cases this can cause irreversible damage. The most advanced stages of PAD can lead to legs and feet with such severe blockage that they do not receive the oxygen-rich blood required for growth and repair of painful sores. This condition, if left untreated, can potentially lead to gangrene, amputation and significant disability.
Risk Factors and Symptoms
- Discomfort, aching, 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 stop.
- Other common sensations are heaviness, tingling, or fatigue. Rest usually helps, but raising your legs – as when you lie in bed – may make the discomfort worse.
- 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.
- 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.
PAD often goes undiagnosed for a long time. Most people mistake the symptoms of PAD as normal aging. Sometimes people experience no symptoms at all until the disease has become advanced. Work closely with your doctor to ensure a greater chance of early diagnosis and treatment if needed.
The same process that causes PAD can also affect the coronary arteries that feed the heart muscle. Patients with PAD are also at risk for coronary artery disease (CAD) and are 4 to 5 times more likely to suffer a heart attack or stroke. Once you are diagnosed with PAD you should also be screened for presence of coronary artery disease.
We use many different types of tests to diagnose PAD. The single most important test is a thorough history and physical examination by a qualified and experienced vascular specialist.
Additional tests may be used to define the severity of the PAD and may include:
Vascular Surgery and Medicine at Inova Heart and Vascular Institute takes a pioneering approach to the treatment of peripheral arterial disease, uniting three kinds of specialists into one program (cardiologists, vascular and interventional radiologists and vascular surgeons) to bring patients a higher standard of care.
Our program is at the forefront of PAD innovations. Substantial investments have been made to create our sophisticated vascular laboratory, which offers advanced non-invasive tests for determining the location and severity of PAD such as duplex ultrasound and CT angiograms.
PAD is a manageable disease in its beginning stages. Early diagnosis and intervention have great potential for improving overall outcome for patients. At Inova Heart and Vascular Institute many cutting-edge treatments for PAD are done as outpatient procedures. Most patients go home the day of the procedure and return to their normal activity within several days.
The goals for treating PAD include managing symptoms so physical activities can be resumed and stopping the progression of atherosclerosis throughout the body. Stopping the progression reduces the risk of heart attacks and strokes.
Treatment options include:
- Lifestyle changes such as increased exercise, a healthy diet and refraining from smoking
- Treatment of existing conditions that may aggravate PAD, such as diabetes, high blood pressure and high cholesterol
- Medications for improving blood flow, such as blood thinners and medications that relax the blood vessel walls
- Endovascular procedures
- Cardiac surgery
Inova's program improves on the traditional manner in which patients are treated. Instead of the patient needing to coordinate multiple specialist referrals and appointments with his or her primary care doctor, Inova has all the right experts in one program, resulting in a treatment program that is better coordinated and less stressful for the patient.