Answers to Common Peripheral Arterial Disease (PAD) Questions

Premier Health doctors answer frequently asked questions about peripheral arterial disease.

What is peripheral arterial disease or PAD?

Premier Health’s Dr. Gary Fishbein explains what peripheral arterial disease or PAD is. Click play to watch the video or read the transcript.

 

The American Heart AssociationOff Site Icon (AHA) defines peripheral arterial disease (also known as peripheral artery disease or PAD) as the narrowing of peripheral arteries—the arteries leading from the heart to the head, arms, stomach and legs. PAD most commonly affects the legs.

The narrowing of arteries in peripheral arterial disease (PAD) is caused by atherosclerosis, the buildup of plaque along artery walls. According to the National Institutes of HealthOff Site Icon (NIH), plaque is formed from fat, cholesterol, calcium and other substances carried by the blood.

According to the American Heart Association, a number of factors increase your risk for atherosclerosis and peripheral arterial disease, including:

  • Smoking
  • Diabetes
  • High blood pressure
  • High cholesterol

To find out more about peripheral arterial disease and risk factors for PAD, talk to your doctor.

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Is peripheral arterial disease a temporary or long-lasting condition?

Premier Health’s Dr. Gary Fishbein discusses the chronic nature of peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

According to the American Heart AssociationOff Site Icon (AHA), peripheral arterial disease is the narrowing of arteries in the extremities. The narrowing is the result of atherosclerosis, the buildup of plaque along the artery walls. Plaque buildup occurs over time as fat deposits, cholesterol, calcium and other substances collect, usually in places where the artery walls are inflamed, often because of vascular damage or weakness.

Peripheral arterial disease (PAD) is considered a chronic condition, both because it takes time to present and because it may persist after treatment. Treatment for peripheral arterial disease may widen and/or reopen blocked arteries, but if risk factors for atherosclerosis are not addressed, arteries may narrow again and PAD symptoms recur.

Talk to your doctor to learn how to manage peripheral arterial disease.

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When someone has peripheral arterial disease (PAD), what causes pain when walking?

Premier Health’s Dr. Gary Fishbein discusses intermittent claudication, a common symptom of peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

According to the Mayo ClinicOff Site Icon, intermittent claudication—pain when walking or climbing stairs—is a common symptom of peripheral arterial disease (PAD).

As the National Center for Biotechnology InformationOff Site Icon (NCBI) explains, your muscles need more blood flow during physical activity. If blood flow is restricted because of narrowed arteries (the defining characteristic of peripheral arterial disease), your muscles do not get the oxygen-rich blood they need. Oxygen-starved muscle fibers trigger pain signals. Pain subsides when activity is stopped because the demand for blood flow is decreased.

However, ceasing all exercise in order to avoid intermittent claudication is not recommended. A sedentary lifestyle may contribute to the development of risk factors for peripheral arterial disease, such as:

Talk to your doctor to find out how to address intermittent claudication and safely exercise for PAD treatment.

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Can you have peripheral arterial disease (PAD) and not know it?

Premier Health’s Dr. Gary Fishbein discusses the symptoms—or lack—of peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

According to the National Center for Biotechnology InformationOff Site Icon (NCBI), many people who have peripheral arterial disease (PAD) have no symptoms at all. In fact, the Women’s Health and Aging study (published in the American Heart AssociationOff Site Icon Journal), which followed nearly 1,000 aging women, reported that 63% of study participants had no leg pain (intermittent claudication).

Impaired function of lower extremities may be the most diagnostically significant symptom of peripheral arterial disease, but loss of function in the legs and ankles is often attributed to aging or arthritis. Even pain in the extremities (claudication) is often attributed to other causes or conditions by patients and their doctors.

To find out if you have peripheral arterial disease or should be tested for PAD, talk to your doctor.

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What are the symptoms of peripheral arterial disease (PAD)?

Premier Health’s Dr. Gary Fishbein talks about the symptoms of peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

According to the American Heart AssociationOff Site Icon (AHA), the most common symptom of peripheral arterial disease is cramping, pain and/or fatigue (i.e. claudication) in the lower extremities (legs, ankles and feet).

In addition to (intermittent) claudication, the Mayo ClinicOff Site Icon identifies a number of other symptoms caused by narrowed arteries leading to the extremities. People suffering from peripheral arterial disease may also experience the following in the legs, feet and/or toes:

  • Coldness, usually on one side
  • Open sores and poor wound healing
  • Change of color (usually a bluish tone)
  • Hair loss or slowed hair growth
  • Slowed toenail growth
  • Shiny skin
  • Weak or absent pulse

Men may also experience erectile dysfunction.

Many of the symptoms of peripheral arterial disease are often mistaken for changes caused by aging or other conditions. Many people suffering from peripheral arterial disease do not experience symptoms at all.

If you experience these symptoms, talk to your doctor about testing for peripheral arterial disease.

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Why is it important to diagnose and treat peripheral arterial disease (PAD)?

Premier Health’s Dr. Gary Fishbein explains why it is important to diagnose and treat peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

According to the National Institutes of HealthOff Site Icon (NIH), 20% of Americans over 50 have peripheral arterial disease. Diagnosis and treatment are vital to preventing permanent damage to the limbs and major cardiovascular events.

Peripheral arterial disease is defined by the narrowing of arteries due to plaque buildup. Narrow arteries choke blood flow to the extremities. At first, loss of circulation may cause (intermittent) claudication—pain, numbness and/or fatigue during activity. Over time, limited blood flow to tissues leads to increasingly severe symptoms, including:

  • Poor wound healing
  • Critical limb ischemia—complete artery blockage in the legs and feet resulting in pain when at rest
  • Gangrene—tissue death

Perhaps most critical is the link between peripheral arterial disease and coronary arterial disease. Both conditions are the result of atherosclerosis—the hardening of arteries. If atherosclerosis is occurring in the lower extremities, it is likely happening in the arteries leading to the heart as well. The National Institute of Health and the American Heart AssociationOff Site Icon (AHA) agree that peripheral arterial disease increases your risk of heart attack and stroke.

To minimize risks associated with peripheral arterial disease, talk to your doctor about diagnosis and treatment.

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What happens if peripheral arterial disease (PAD) goes undiagnosed or untreated?

Premier Health’s Dr. Gary Fishbein discusses the risks of untreated peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

The American Heart AssociationOff Site Icon (AHA) defines peripheral arterial disease (PAD) as the narrowing of arteries leading to the head, arms, stomach and legs. Narrowing may be partial, allowing some circulation, albeit significantly limited. However, as Premier Health’s Dr. Fishbein explains, the longer peripheral arterial disease goes undiagnosed, the more likely plaque will continue to build up and completely block arteries.

Arteries that are completely blocked introduce more severe symptoms and health complications, like critical limb ischemia, which can lead to gangrene. Treatment options also become more invasive. Amputation may be required to remove dead tissue and prevent spreading infection, and/or vascular surgery may be necessary to clear blockage.

Talk to your doctor about early diagnosis and treatment to prevent complications arising from peripheral arterial disease.

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How is peripheral arterial disease treated in its early stages?

Premier Health’s Dr. Gary Fishbein talks about early treatment for peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

According to the American Heart AssociationOff Site Icon (AHA), peripheral arterial disease may be effectively treated with lifestyle changes and medication for most people.

The Mayo ClinicOff Site Icon states that treatment of peripheral arterial disease in the early stages has two main goals:

  1. To manage symptoms (i.e. intermittent claudication) so that you may continue physical activities with little or no pain
  2. To minimize your risk factors for peripheral arterial disease/atherosclerosis so that blockage in the arteries may be stopped and possibly reversed

Smoking increases the risk of peripheral arterial disease fourfold, so quitting is the single most important lifestyle change smokers can make to improve their health. For nearly all patients with PAD, a supervised exercise (walking) program is recommended PAD treatment in the early stages. Because high blood pressure, high cholesterol and diabetes are also PAD risk factors, managing these conditions through a healthy diet may also be effective. Your doctor may also prescribe medications to manage blood pressure and lower cholesterol to complement lifestyle changes.

For more information about early peripheral arterial disease treatment, talk with your doctor.

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What treatment options are available for those who suffer with peripheral arterial disease (PAD)?

Premier Health’s Dr. Gary Fishbein explains the range of treatment options available to people with peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

According to the American Heart AssociationOff Site Icon (AHA), peripheral arterial disease (PAD) treatment aims to reduce symptoms and slow or prevent the progression of arterial blockage. In the early stages of the disease, these goals may be achieved with lifestyle changes, such as:

  • Quitting smoking
  • Eating a healthy diet
  • Participating in a supervised exercise (walking) program

Medications may also be prescribed to:

  • Lower blood pressure
  • Lower cholesterol
  • Manage blood sugar
  • Prevent clots
  • Relieve pain

More severe arterial blockage may require surgical intervention. There are a number of procedures that may be used to treat peripheral arterial disease, including:

Premier Health cardiologists use the latest technology—Ocelot—to drill through arterial blockages without damaging vessel walls.

For more information about treatment options for peripheral arterial disease, talk with your doctor.

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How is severe peripheral arterial disease (PAD) treated?

Premier Health’s Dr. Gary Fishbein discusses treatment of severe peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

If peripheral arterial disease is not diagnosed or treated early, plaque continues to build up along artery walls and may eventually completely block blood flow. When arteries are completely blocked, more invasive treatment methods are necessary to restore blood flow to the lower extremities and prevent tissue death.

The National Center for Biotechnology InformationOff Site Icon (NCBI) outlines three major types of surgical procedures that may be used to treat severe peripheral arterial disease:

  • Bypass grafting—a vessel from another part of your body or a synthetic vessel is grafted above and below the blockage site, allowing blood to flow around the blocked artery.
  • Angioplasty and stenting—a thin tube (catheter) with a balloon is threaded through the clogged artery. The balloon is inflated, flattening plaque along the artery walls. A metal mesh (stent), which may also contain clot-preventing medication, may be placed at the balloon site as well.
  • Endarterectomy (atherectomy)—a thin tube (catheter) is threaded through the artery and cuts through or dissolves the blockage.

As Dr. Fishbein explains, Premier Health cardiologists use the latest technology—the Ocelot—to perform endarterectomies. This device uses a laser fiber to cut through arterial blockage and a camera that allows the surgeon to see what is going on so that arterial walls are not damaged during the procedure.

To find out what treatment options are available for your peripheral arterial disease, talk with your doctor.

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How is Ocelot used in the treatment of peripheral arterial disease (PAD)?

Premier Health’s Dr. Gary Fishbein explains how Ocelot is used in the treatment of peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

Ocelot is an advanced device used in endarterectomy (atherectomy) surgery to restore blood flow that has been blocked because of peripheral arterial disease.

According to AvingerOff Site Icon, the maker of Ocelot, the device is the first of its kind that allows real-time Optical Coherence Tomography (OCT). In other words, surgeons can see what is happening inside the artery as the device’s laser fiber drills through the blockage.

By creating a channel through the blockage and removing plaque from the artery walls, space is made for blood to flow unimpeded from the heart to the lower extremities. Restored blood flow relieves symptoms associated with peripheral arterial disease and may prevent complications like gangrene and the need for limb amputation.

For more information about how Ocelot works, talk with your doctor.

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What is Ocelot and how does it benefit patients with severe peripheral arterial disease (PAD)?

Premier Health’s Dr. Gary Fishbein discusses the benefits of Ocelot to patients with peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

While most people with peripheral arterial disease may be effectively treated through lifestyle changes and medication, some may require surgery to restore blood flow and relieve symptoms of peripheral arterial disease. One surgical option is an endarterectomy (atherectomy), a procedure that removes plaque from the artery.

Premier Health cardiologists use the Ocelot catheter for endarterectomy procedures. This device has a camera and a laser fiber. The camera allows the surgeon to see the inside of the artery while the laser fiber drills through the blockage.

The major benefit of being able to see the procedure from inside the artery while it is being performed is increased patient safety. Visibility allows the surgeon to cut away the plaque without damaging artery walls. Visibility also allows the surgeon more precision for other artery opening procedures like ballooning (angioplasty) or stent placement.

The Ocelot catheter allows more people to be treated with minimally invasive surgical procedures.

For more information about Ocelot technology, talk with your doctor.

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How is peripheral arterial disease (PAD) diagnosed and treated?

Premier Health’s Dr. Gary Fishbein discusses diagnosis and treatment of peripheral arterial disease (PAD). Click play to watch the video or read the transcript.

 

There are a variety of testing methods doctors may use to determine if you have peripheral arterial disease. Your doctor will develop a treatment plan based on results—i.e., the location and severity of artery blockage.

A patient’s vascular history and description of symptoms may be enough for a doctor to diagnose peripheral arterial disease (PAD). However, confirming the diagnosis and/or assessing the location and severity of the blockage may require further testing. The National Center for Biotechnology InformationOff Site Icon (NCBI) outlines a number of diagnostic tests, including:

  • Ankle-brachial index (ABI)—compares blood pressure in the ankle and arm to determine if blood flow is restricted to limbs. This test may be done before and after exercise on a treadmill.
  • Doppler ultrasound—uses sound waves to create an image of blood flow in the major arteries of the legs.
  • Magnetic resonance angiogram—uses magnetic and radio waves to create an image of blood flow in the legs.
  • Arteriogram—uses a contrast dye visible on an X-ray to determine where blood flow is restricted.

Most of the tests to diagnose peripheral arterial disease are non- or minimally invasive. However, more invasive tests may be necessary to pinpoint the exact location of arterial blockage.

Treatment for peripheral arterial disease is based on the severity of the condition. From least invasive to most invasive, treatment options include:

  • Lifestyle changes, including diet and exercise
  • Medications
  • Vascular surgery, including angioplasty, bypass and/or endarterectomy (atherectomy)

Your primary care physician may refer you to a specialist for treatment.

Talk to your doctor to find out if you have peripheral arterial disease and what treatment options may work best for you.

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What are the risk factors for peripheral arterial disease (PAD)?

According to the American Heart AssociationOff Site Icon (AHA), peripheral arterial disease (PAD) is caused by atherosclerosis—a buildup of plaque along artery walls. Risk factors for PAD are those that contribute to atherosclerosis—high blood pressure, high cholesterol and smoking.

In addition to these risk factors, the Mayo ClinicOff Site Icon identifies a number of other factors that may increase your risk for peripheral arterial disease, including:

  • Diabetes
  • Obesity
  • Age (over 50)
  • Family history of PAD or other cardiovascular disease
  • High homocysteine levels (an indicator of inflammation)

Some risk factors may require a physical examination or blood tests to evaluate.

Talk to your doctor to learn more about your risk for peripheral arterial disease.

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Source: Gary J. Fishbein, MD, FACC, Dayton Heart Center

Content Updated: January 11, 2017

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