Peripheral Artery Disease (PAD) is a disease of the blood vessels that occurs outside of the vessels of the heart and brain characterized by a progressive narrowing of the blood vessels most often caused by a process called atherosclerosis. Atherosclerosis (see illustration below) is a condition in which a plaque or a fatty substance collects along the inner lining of the arterial wall. This substance hardens and thickens which, over time, may block the normal blood flow in the artery. These blockages impair the blood circulation to the arms, legs, stomach, head and kidneys causing damage to the tissue.
In the early stages of this process people may experience cramping or fatigue in the legs or buttocks with activity such as walking that resolves with rest. This sensation is referred to as "intermittent claudication." Peripheral arterial disease is also indicative of atherosclerosis in other parts of the body such as the head and heart, increasing the risk for stroke and cardiovascular death. Early detection is essential for improvement in your quality of life and prevention of a major disability.
- Family History
- Increasing Age -- Men over 60 years of age
- Women after menopause have the same risk factors as men over 60
Diagnosis of peripheral arterial disease is made by taking a complete medical history, physical exam and any one or more of the following studies: duplex ultrasound, computed tomography (CT) angiography, and magnetic resonance (MR) angiography. Non-surgical Management of PAD Many people with PAD can be managed with non invasive therapies such as lifestyle changes, medication, or both.
Lifestyle and Medical
Modification of risk factors:
- Smoking Cessation
- Diabetes control
- Blood Pressure Management
- Physical Activity
- Diet low in saturated fats
- Cholesterol Medication
- Antiplatelet therapy such as aspirin or clopidigrel
- Cholesterol lowering agents referred to as statins: simvastatin, atorvastatin, or pravastatin
- Medications that may assist with walking distance, cilostazol or pentoxifylline.
- ACE Inhibitors
Normal Artery vs. Artery With Plaque
Surgery and Endovascular Therapies
Where there is no improvement with lifestyle changes and drug therapy, endovascular or surgical intervention may be recommended.
Endovascular therapies are minimally invasive non-surgical techniques that can be used to open and/or widen peripheral vessels that have become narrowed or blocked.
Vascular specialists at UCSF may use
angioplasty (ballooning) and or stenting to keep the vessel open.
Surgical intervention may be recommended based on the size and
location of the blockage. This technique bypasses the area of
the blockage by using a vein or prosthetic vein to route blood from
the area above the lesion in the vessel to an area below, restoring
blood flow to the area.