Peripheral Arterial Disease (PAD) - New York Cardiovascular Associates
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Cardiology

Peripheral Arterial Disease (PAD)
What does PAD mean?

• Peripheral arterial disease refers to narrowing in the arteries of lower extremities causing obstruction to normal blood flow.
• The most common cause of PAD is atherosclerosis which is a buildup of plaque in the arteries.

Risk factors for PAD:

• Hypertension
• Dyslipidemia
• Diabetes Mellitus
• Cigarette smoking ( former or active smoker)

Signs/Symptoms of PAD:

• Leg pain/ache/fatigue or other forms of discomfort occurring in the hip/thigh/calf region while walking. It may resolve after several minutes of rest.
• Leg pain at rest.

Other problems of the lower extremities Include:

• Skin ulcers
• Muscle atrophy
• Smooth and/or Shiny skin
• Distal hair loss
• Thick and/or brittle toenails

Testing for PAD:

Early diagnosis and treatment of PAD is important to prevent worsening or the development of other conditions including critical blood flow insufficiency, stroke, heart attack or loss of a limb. Our physicians will assist in determining the best testing needed for you. These are all done in our office.

Ankle –Brachial Index (ABI): A special ultrasound probe is used to determine the ratio of the blood pressure in the ankle to blood pressure in the arm.

Pulse Volume Recording (PVR): Cuffs are simultaneously placed on the right and left high thigh, mid-thigh, calf, ankle and feet measuring the blood volume in the arteries. Changes in the blood volume may be suggestive of PAD requiring further imaging.

Exercise Testing: Measuring ABI/PVR waveforms before and after exercise provides additional information on the leg circulation. Patients walk on a treadmill at a constant speed and incline for at least five minutes or until symptoms occur. Upon onset of symptoms, the treadmill is stopped and patients are brought back to the examining table. ABI and PVR waveforms are measured. If there is a drop from pre-exercise to post-exercise measurements, you will be referred to have an ultrasound of the leg for further evaluation.

Ultrasound Imaging: If above tests are abnormal and/or symptoms persist, your physician may order an ultrasound of the arteries in your lower extremities. This test allows your cardiologist to visualize the arteries and assess for any type of obstruction/plaque buildup causing symptoms. After completion of this test, you will meet with your cardiologist to discuss treatment plans and further management.

>> Read more about testing for PAD.

Treatment of PAD:

Initially your cardiologist may recommend conservative medical management and aggressive risk factor modification. This includes control of high blood pressure, high cholesterol and diabetes by diet, exercise, weight loss, smoking cessation and/or medical therapy. This basic approach is crucial in the management of PAD and all atherosclerosis diseases.

If symptoms persist despite risk factor modification and medical management, your cardiologist may recommend a peripheral angiogram. This ambulatory procedure can be done in our office or hospital depending on what is best for you. It is approximately 2-3 hours in duration. Mild sedation may be given in additional to local anesthesia. During the test, a long slender tube called a catheter is inserted into an artery in the groin or wrist. This catheter is slowly and carefully threaded through the artery until it reaches the segment of blood vessel with the obstruction/plaque buildup. A small amount of contrast material is injected into the blood vessel segment and x-ray images are taken. The physician will study the images to determine the most beneficial treatment.

One type of treatment is an angioplasty. A balloon wrapped catheter is advanced into the blocked artery and inflated until it is relieved. The physician may also decide to place a stent in the artery to keep the vessel open. After angioplasty and/or stenting are completed, the catheters are removed and the artery is sealed by a closure device.

After completion of peripheral angiogram, patients will be monitored for 4-6 hours by our skilled nurses. Prior to discharge, the nurse will discuss post- angiogram instructions and answer any questions you may have. The physician will discuss the outcome of procedure in detail with you. Patients are advised to follow-up with their cardiologist one week after the procedure.

New York Cardiovascular Associates