Diseases and conditions

What is peripheral arterial disease?

Peripheral arterial disease (PAD) is a common condition affecting 20 percent of Americans age 65 and older. PAD develops most commonly as a result of atherosclerosis, or hardening of the arteries, which occurs when fat, cholesterol, calcium, and other substances found in the blood build up and form a substance called plaque inside the arteries.

The plaque blocks blood flow and prevents oxygen from reaching tissue. The decreased blood flow can cause pain, sores, or even dead tissue that can lead to gangrene and amputation and may cause strokes or heart attacks.

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Symptoms and risk factors
Diagnosis
Treatment
- Lifestyle changes
- Interventional options
Critical limb ischemia

Stent angioplasty

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What are the symptoms of peripheral arterial disease?

Some people experience pain, cramping or heaviness in their legs while walking (also called intermittent claudication), which prevents them from enjoying their lives. You may have PAD if you experience the following during activity:

Aching, throbbing legs
Pain and cramping
Numbness
Tingling
Weakness
Burning
Discolored skin
Wounds on the leg or foot that won’t heal

Who is at risk for developing PAD?

You may be more likely to have PAD if, among other factors, you have:

High cholesterol
High blood pressure
Diabetes
Obesity
A history of smoking
A family history of vascular disease, such as PAD, aneurysm, heart attack or stroke

In addition, those over 50 and those who do not exercise are more likely to develop PAD.

How is PAD diagnosed?

An interventional radiologist can help determine if you have PAD through a simple test called an ankle brachial index test, or ABI, that compares the blood pressure in the upper and lower limbs.

PAD can also be diagnosed through an angiography using imaging techniques such as ultrasound, CT and MRI.

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How do IRs treat peripheral arterial disease?

Lifestyle changes and medical management

Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.

In addition, medications that lower cholesterol or control high blood pressure may be prescribed. Other medications that prevent blood clots or the buildup of plaque in the arteries may also be prescribed. Management with medication has been shown to significantly increase pain-free walking distance and total walking distance in individuals with intermittent claudication.

An interventional radiologist can prescribe such treatments and monitor your condition through regular follow-up visits to monitor disease progression. An IR will also work with your care team.

Interventional options

If lifestyle changes and medical management aren’t enough to treat your PAD, you might benefit from a minimally invasive interventional radiology treatment. In most cases, the IR will make a small incision in your groin and, using X-rays or other imaging to guide him, thread a very thin catheter through your blood vessels to the blockage or narrowed artery. Depending on where the blockage is and how it looks, it may be treated it in several ways.

Angioplasty: Angioplasty uses inflatable devices called balloons to open up narrowed arteries. Various types of balloons are used in different situations, including balloons that stretch arteries open, metal-edged balloons that cut and break up calcium deposits, and drug-coated balloons that can prevent scarring and future narrowing of the artery. During angioplasty, the interventional radiologist guides a catheter with a tiny balloon tip through the blood vessels into the blockage. The balloon is inflated to widen the artery, which restores blood flow.

Stenting: Sometimes, following balloon angioplasty, the doctor will place a stent (a tiny mesh tube) in the artery to help keep it open. Those who receive stents will also need to be on clot-preventing medications to reduce the chance of clots forming inside the stent.

Thrombolysis: Thrombolysis, which is usually enacted in an emergency because the body has not had enough time to respond by growing new blood vessels to bypass the blockage, is a treatment that delivers medication slowly, over 12–24 hours, to a blood clot through a thin tube that is inserted next to or within the clot. You’ll be hospitalized during the treatment and will be watched by nurses and doctors in the intensive care unit. Often, the clots will dissolve but the artery will still be narrowed, and additional treatments may be required.

Thrombectomy: When a blood clot suddenly blocks blood flow, a treatment known as a thrombectomy will remove the clot from the body using various medical tools that can draw out, pull out, or vaporize the clot.

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Doctor consoling patient

What can I expect during treatment?

Once the treatment is completed, the IR removes the catheter and applies pressure to the tiny incision in your groin to allow it to heal. You will then lie flat on your back for several hours. Usually, you will be able to go home the same day, but there is a small chance you will be observed overnight and discharged in the morning. During a period of regular follow-up appointments, which can include ultrasound or other imaging tests, your IR will monitor your progress after the therapy.

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Critical limb ischemia

Ischemia is a serious condition in which there is inadequate blood flow and oxygen to a specific part of the body, generally caused by a narrowing or blockage of an artery. Critical limb ischemia, or CLI, results in severe pain (often at rest) or tissue loss, such as a non-healing sore or even gangrene, related to peripheral artery disease. If the tissue of the limb has been affected; this requires immediate attention.

Critical limb ischemia is serious and will not improve on its own. An interventional radiologist will perform angiography to help determine if revascularization (opening up) the blocked artery will help your condition. The poor prognosis demands a multidisciplinary approach involving interventional radiologists who are specialists in endovascular revascularization, surgeons, podiatrists, wound care experts and other specialties to maximize patient outcomes.

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Disclaimer: SIR is providing this information as a public service. SIR assumes no liability, legal, financial or otherwise for the accuracy of this information or the manner in which it is used. SIR does not offer medical advice. This information is being provided for informational purposes only and should not be used to replace professional medical advice. It is best to seek advice and attention from your physician or qualified health care professional.

Diseases and conditions

Peripheral arterial disease

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