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PAD – The Pervasive Silent Crippler — Part 2 of 2

  March 06, 2015
By James B. Williams, MD

Last month we learned about the possible risk factors of peripheral arterial disease (PAD). PAD is a term used to classify disease in the peripheral arteries. Simply stated, PAD is the buildup of plaque in the walls of arteries, which reduces or blocks the flow of blood through the legs. This month we will cover the symptoms, diagnosis, and treatment.

The most common symptom associated with PAD is claudication — pain or cramping in the buttocks, legs, or feet — that is noticeable during activities such as walking or climbing stairs. Other common symptoms of PAD include leg pain at rest, impaired walking, wounds or sores that do not heal on the legs or feet, color changes (paleness, blueness) in the skin of the feet, lower temperature in one leg compared with the other, poor toenail growth, and/or decreased hair growth on the toes and legs.

In more than half of cases, an individual with progressing PAD will not have typical signs or symptoms, but that does not mean they should not talk with their physician or be treated. Early treatment of PAD is key to managing the disease long term. Diagnosing PAD can be done quickly and noninvasively in a physician’s office. Oftentimes, it is as simple as checking the feet for signs of PAD.

People at risk for PAD should talk with their physician to see if they should undergo testing to determine the presence of PAD. During this visit, the physician will take a medical and family history, will perform a physical, and may conduct a simple diagnostic test. During the physical exam, the health care provider may check pulses in the legs and feet; look at the color, temperature, and appearance of the legs and feet; and look for sores that are not healing on the legs and feet.
  • Ankle-brachial index: A health care provider may perform a simple, noninvasive test called an ankle-brachial index (ABI) test. Painless and quick, the ABI compares the blood pressure readings in the ankles with those in the arms. This test can determine whether someone has PAD, but it cannot identify which arteries are affected.
  • Doppler ultrasound: Doppler ultrasound testing uses sound waves to measure the blood flow through the leg and may be used to determine if a specific artery is open or blocked. The test is painless and does not require the use of needles, dye, or X-ray. Patients with documented PAD are referred to a specialist for treatment.
  • Angiography/Fluoroscopy: Angiography is a minimally invasive test that uses X-ray imaging to show exactly where in a vessel blockage is located and the extent of disease. During this procedure, a small tube (catheter) is inserted into an artery in the groin or arm and contrast dye is injected through the catheter. Then, images of the vessels are projected onto a screen for viewing; this helps to determine exactly where blockages occur and then helps to guide treatment.
There are three main approaches to treating PAD: lifestyle changes, medication to control things like high blood pressure or high cholesterol, and minimally invasive (endovascular) procedures or surgery. Early diagnosis and treatment will ensure treatment options are broadest and can reduce the risk of developing critical limb ischemia or undergoing more invasive treatments, including amputation.

Minimally invasive treatment options for PAD include atherectomy, angioplasty, and stenting — all of which restore blood flow through a narrowed artery, either by removing the plaque or displacing it. More severe cases of PAD may require a surgical procedure to bypass the blocked artery.

Untreated PAD, or diagnosing the disease too late in its progression, may lead to removing a diseased portion of the leg or foot. In some cases, amputation is necessary. However, up to 85 percent of amputations are preventable, if the disease is diagnosed early and treated through a minimally invasive procedure.

This concludes the two part article. If you are concerned that you or a loved one may have PAD, contact the Cardiac Thoracic & Endovascular Therapies, S.C., at 309-680-5000. Dr. Williams is board-certified in three surgical specialties: cardiothoracic, vascular, and general. “Easy in, Easy Out” service advantages. Visit Located at 2420 W. Nebraska Avenue, Peoria, IL.

Photo credit: izusek/iStock Back to Top

March 06, 2015

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