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Vascular Surgery - Peripheral Arterial Disease (PAD)

Peripheral arterial disease (PAD), also called peripheral vascular disease (PVD), develops as a result of build up of fatty deposits and plaque in the lining of blood vessels. This process is known as atherosclerosis.  When plaque builds up, the vessels become hard and narrow causing poor circulation. The primary symptom is pain in the legs while walking. If left untreated the circulation may worsen causing painful foot ulcers and infections that may require amputation.

Risk factors:

Family history of atherosclerosis, high blood pressure, diabetes, high cholesterol, and advanced age, and smoking

Symptoms:

People who have PAD may experience pain in their hips, thighs, or calves when they walk or run. The pain often goes away when the exercise stops.

Other symptoms can include hair loss on the legs, slow-healing sores on the legs, changes in the skin on the legs and feet, impotence, pain in the toes when lying flat, paleness of the legs when they are elevated, and reddish-blue discoloration of the extremities.

PAD often goes undiagnosed. It is important to inform your physician if you have symptoms of PAD because the condition can lead to increased risk for heart attack and stroke.

Diagnosis and Tests:

Your doctor will ask you specific questions regarding your complaints; usually the history you provide will lead them to the diagnosis of PAD. If your doctor suspects your symptoms are caused by PAD he/she may order tests including:

Ankle-brachial index (ABI) - This test compares the pressure in the legs and arms. The test is quick and painless and can be performed in the doctor's office.

Duplex ultrasound- also performed in the doctors office this test gives second to second pictures of the blood vessels and the blood flow in the vessels.

CT scan or MRA- These are also non invasive and painless tests that provides the doctor pictures of the blood vessels, giving more details about the location and severity of the disease.

Treatment:

Lifestyle changes and medications: Mild symptoms can be treated with lifestyle changes such as quitting smoking, control of diabetes, and daily exercise. Medications that improve blood flow may also be beneficial. If the disease is severe procedures may be needed to restore more blood flow.

Surgical Revascularization: If the disease is advanced balloon angioplasty and stent placement may not restore enough circulation. In such case, a surgical bypass may be needed.  The procedure is performed by making 2 to 3 incisions on the leg and using either the patients own vein or a synthetic graft the diseased area is bypassed.

Angioplasty and Stent:  With the use of X-ray guidance a small balloon attached to a flexible catheter is inserted into a blood vessel and directed to the site of the blocked artery.  The balloon inflates and opens the vessel. If the vessel doses not stay open a stent (tube shaped metal scaffolding) may be inserted to keep the artery open. The patient is usually sent home the same day. The physicians at SIUH specialize in this minimally invasive approach to the treatment of PAD. 

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