Dr. Steven Filby is an interventional cardiologist at The Cardiology Center of Watauga Medical Center, and director of the Cardiac Catheterization Laboratory at Watauga Medical Center. Dr. Filby’s practice focuses on the medical and percutaneous treatment of coronary artery disease and peripheral vascular disease. Learn more about Dr. Filby >

One in twenty American adults has peripheral arterial disease, or PAD, a narrowing of the blood vessels caused by cholesterol plaque buildup. Several different risk factors contribute to the development of PAD:

  • advanced age
  • smoking
  • diabetes
  • high blood pressure
  • high cholesterol.

A family history of PAD also increases one’s risk. Those with PAD may experience pain in the calf muscle or buttock with walking, especially brisk walking or walking uphill. Some patients may develop skin discoloration of the toes or feet and even develop ulcerations and wounds that are slow to heal.

PAD is a slow-burning emergency and an indication of vascular disease throughout the rest of the body.

Patients with PAD have a seven-times increased risk of stroke and heart attack and may suffer limb loss due to serious a skin infection called gangrene. Yet many with PAD have no knowledge of having the disease.Click To Tweet

Patients with PAD have a seven-times increased risk of stroke and heart attack and may suffer limb loss due to serious a skin infection called gangrene. Yet many with PAD have no knowledge of having the disease and go undiagnosed as symptoms may be attributed to other causes such as joint pain or back disease.

Alarmingly, many with the disease have no symptoms at all. Studies have shown that the disease may be overlooked even if a patient is followed by a cardiovascular specialist.

 

Illustration_Peripheral_Arterial_Disease

 

Diagnosing PAD

 

Diagnosing PAD involves a noninvasive test called an ankle-brachial index or ABI in which a reading is taken of the arms and the legs using a standard blood pressure cuff and the ratio of these readings is used to assess blood flow to the lower extremities (legs and feet). A provider may also recommend more advanced imaging such as Magnetic Resonance (MR) or Computed Tomography (CT) scans.

Once diagnosed, patients are treated according to the severity of their symptoms and care is also focused on the prevention of future events. Patients may be started on medications in conjunction with a walking program to improve their symptoms. If medicine and lifestyle intervention are unsuccessful or if a patient’s lower extremity is in jeopardy, a procedure to improve the circulation may be indicated.

Peripheral Arterial Disease (PAD) is a slow-burning emergency and an indication of vascular disease throughout the rest of the body.Click To Tweet

 

Treatments for PAD

 

There are several minimally invasive procedures that can improve the blood flow to the lower extremities. These so-called “endovascular” procedures are done under fluoroscopic (a type of X-ray) guidance and utilize small medical tubes called catheters to deliver therapy. A small balloon may be threaded into the blockage and used to dilate the vessel, called angioplasty. New technology allows these balloons to deliver medication to the blockage to prevent vessel re-narrowing after the procedure.

In a similar way, small metal-alloy tubes called stents can also be used to expand the blockage from within and also may have medication coating to keep the vessel open. These minimally invasive procedures often allow the patient to be treated and sent home on the same day. If a patient is not a candidate for an endovascular approach, a more traditional open surgery called surgical bypass may be required.

 

Living with PAD

 

  • All patients with PAD should have their medications adjusted to prevent heart attack and stroke—the major health threats to those with this disease.
  • Taking daily aspirin and cholesterol-lowering medications can dramatically reduce the incidence of serious health events.
  • Blood pressure and blood sugar levels for diabetic patients need to be strictly controlled.
  • Patients with PAD should exercise caution with skin and nail care. The skin of the feet should be kept clean and moisturized to prevent cracking and infection. Frequently, podiatrists are consulted for routine care so as to prevent inadvertent injury during nail trimming.
  • Finally, it is absolutely critical that PAD patients quit smoking.

Accurate diagnosis of PAD is important as it allows for comprehensive changes to both lifestyle and medications which can save lives. New technologies are available which help to restore circulation in those affected. Early recognition of PAD is essential to halting this insidious and sometimes silent disease.

Do you have risk factors or symptoms of PAD?

The Cardiology Center can help. Schedule an appointment with one of our highly skilled providers today.