Peripheral Arterial Desease

Atherosclerois or hardening and narrowing of arteries can affect the arteries going to the legs.  The results of the low blood flow to the legs can range from muscle cramping when walking to poor wound healing with gangrene and eventual loss of legs.  This range of disease depends on how severe the narrowings are and how much the blood supply to the leg is decreased.  The risk factors for PAD are:

- Smoking
- Diabetes
- Bad Cholesterol
- High Blood Pressure
- Family History


Diagnosis is made often with a combination of physical examination, history and a simple leg blood pressure test called an ankle brachial indices (ABI) with specialized ultrasound equipment.  These studies performed at Savannah Vascular not only detect the presence of PAD but the severity and location of the problems.  Other diagnostic tools include CAT-scan and MRI and angiography or catherization to diagnose the narrowings in the arteries.



 P.A.D. develops slowly over many years. In the early stages, most people with P.A.D. have no symptoms. Only about one out of three people with P.A.D. actually feel there is something wrong with their feet or legs. By that time, their arteries may be so clogged or hardened that they are not getting enough oxygen to supply their leg muscles and they may develop non-healing wounds.

Lower-extremity P.A.D. is a serious disease that affects about 8 million Americans. The hardened arteries found in people with P.A.D. are a sign that they are likely to have similar hardening and narrowing of the arteries to the heart and the brain. That is why people with P.A.D. are at high risk for having a heart attack or a stroke.


When the blood flow to the legs is greatly (or severely) reduced, people with P.A.D. may have pain when walking. P.A.D. may cause other problems that can lead to amputation. People with P.A.D. may become disabled and not be able to perform their daily activities. As time goes on, they may have a very poor quality of life.

Primary treatment of P.A.D is preventative by stopping smoking, using aspirin or other platelet drugs, cholesterol pills and exercise.  This preventative  strategy can also reverse some of the more mild early stages of the disease.  Treatment currently involves minimally invasive angioplasty and stenting in 80% to 90% of cases.  Bypass operations were the blockage is bypassed using an extra leg vein or artificial grafts are an important and durable method of treating P.A.D but are typically reserved for more complex disease.

These life saving steps will help to prevent and control P.A.D.:

•      Get help to quit smoking and set a quit date now.
•      Lower your blood pressure to less than 130/80 mmHg if you have diabetes or chronic kidney disease.
•      Lower your LDL (bad) cholesterol to less than 100 mg/dl. If you are at very high risk for a heart attack or stroke, your health care provider may recommend an LDL goal of less than 70 mg/dl.
•      Manage your blood glucose to reach an A1C level of less than 7 and practice proper foot care if you have diabetes.
•      Talk to your doctor about taking anti-platelet medicines such as aspirin or clopidogrel to prevent clotting.
•      Follow a healthy eating plan to control your weight, blood pressure, cholesterol and blood glucose (for diabetes).
•      Get regular exercise such as walking for 30 minutes at least 3 or 4 times per week. If you have pain or cramps in your legs, ask your health care provider to refer you to a special PAD exercise program. Also, talk with your provider about using medicines such as cilostazol (pletal) to improve your walking ability.

Angioplasty and stenting

In some cases of peripheral artery disease, your physician may recommend angioplasty and stenting. This procedure is considered to be minimally invasive in comparison to open surgery. It is most effective for more localized blockages in the larger arteries. During an angioplasty, your physician inserts a long, thin, flexible tube called a catheter into a small puncture over an artery in your arm or groin. The catheter is guided through your arteries to the blocked area. Once in place, a special balloon, which is attached to the catheter, is inflated and deflated several times. The balloon pushes the plaque in your artery against your artery walls, widening the vessel and increasing blood flow.  In some circumstances, your vascular surgeon may then place a tiny mesh-metal tube, called a stent, into the narrowed area of your artery to keep it open.



The stent remains permanently in your artery. After this procedure, blood flows more freely through your artery. Other devices, such as athertectomy catheters, actually remove the plaque but have a more limited role.


















Bypass Surgery

Bypass surgery creates a detour around a narrowed, or blocked, section of a leg artery. To create this bypass, your vascular surgeon uses one of your veins or a tube made from man-made materials. Your vascular surgeon attaches the bypass above and below the area that is blocked. This creates a new path for your blood to flow to your leg tissues and is particularly effective for extensive artery blockages.



Leg Pain - When is Peripheral Arterial Disease (PAD) the Cause

The following short movie details this procedure: Click Here

http://www.americanheart.org/presenter.jhtml?identifier=3020242
http://www.padcoalition.org/wp/what-is-pad/
http://www.sirweb.org/patPub/pvdPad.shtml