Diseases and conditions

Get a pulse on PAD

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Peripheral arterial disease (PAD) is a common condition affecting 1 in 20 Americans age 50 and older. PAD happens when arteries in the legs narrow, reducing or cutting off blood flow, and is a leading cause of non-trauma related amputations when not diagnosed and treated early. More than 400 non-traumatic amputations happen every day as a result of PAD.

Kick off the conversation with your doctor to see if you are at risk or may have PAD. The PAD Pulse Alliance has developed a toolkit that provides resources, such as a family and medical history questionniare and questions to ask you doctor at every stage of your treatment. This toolkit meets you where you are in your PAD journey, whether you're recently diagnosed, weighing your treatment options, getting back to daily life after treatment, or simply want to know more.

Download the "PAD & You" Toolkit

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

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Could it be PAD? What are the signs and symptoms of peripheral arterial disease?

Signs and symptoms of PAD can easily go unrecognized or be dismissed.

Leg pain that occurs while walking and stops with rest is one of the first symptoms of PAD, but 91% of Americans would dismiss leg pain as just part of getting older.

You may have PAD if you experience the following:

One foot may feel colder than the other
Your foot or leg may become pale, discolored, or blue
Leg weakness or numbness may make you feel off-balance or make it harder to walk.
Your toenails and leg hair may stop growing.
You may have pain or a feeling of pins and needles in your leg or foot.
Sores or wounds on your toes, feet, or legs may appear, may heal slowly, or may not heal at all.

Know your 3 for PAD. Who is at risk for developing PAD?

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

Diabetes—people with diabetes are 3–4 times more likely to develop PAD
High blood pressure—35–55% of people with PAD are likely to suffer from high blood pressure
A history of tobacco use—80% of patients with PAD formerly used tobacco, either smoking or chewing

Other risk factors for PAD include:

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

Who suffers most? PAD health disparities

Black and Hispanic Americans experience PAD and its devastating consequences more frequently.

Black people are 2 times more likely to suffer from PAD and up to 4 times more likely to undergo an amputation.
Hispanic Americans present with more progressive PAD, leading to worse outcomes, including greater risk of amputation.

Don’t ignore any symptoms related to PAD

If you experience leg pain while walking, that goes away after sitting down, contact your doctor. This is a common sign of PAD and should not be ignored. Screening for PAD is easy, quick, and non-invasive and can be done in your doctor’s office.

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, which compares your ankle’s blood pressure with your arm’s blood pressure. Your doctor will use a blood pressure cuff and ultrasound device for this quick and painless test. If your blood pressure is lower in your leg when compared to your arm, this can indicate narrowing or blockage of the arteries, or blood vessels, in the legs.

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

Early stages of PAD can often be treated with lifestyle changes. Exercise, a heart-healthy diet and quitting tobacco use can 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 you have later-stage PAD, or if lifestyle changes and medical management aren’t enough to treat your PAD, you might benefit from a minimally invasive interventional radiology treatment. These treatments for those with severe symptoms not relieved by lifestyle changes alone, help to remove blockages and preserve toes and limbs.

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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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.

PAD Resources for You

Never heard of PAD? You’re not alone, 70% of Americans aren’t aware of PAD (PAD Pulse Alliance Survey). The "PAD & You" toolkit is a one-stop interactive resource that provides educational materials such as questions to ask you doctor and informational videos. This toolkit meets you where you are in your PAD journey, whether you want to learn more, recently diagnosed, weighing your treatment options or getting back to daily life after treatment.

Download toolkit

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Doctor Finder is the most comprehensive database of interventional radiologists practicing in the United States and internationally. Use the search fields on the left side of the screen to search based on geographic location or by state or country. If you already know the name of an IR in your area, you can enter their last name.

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