Peripheral Artery Disease Specialist

What is peripheral artery disease?

PAD is a hardening and narrowing of the arteries. It can occur in any artery, but it is most common in those that carry blood to the legs. It occurs as a result of plaque build-up clogging the arteries and restricting blood flow, a condition known as atherosclerosis. PAD increases your risk for having a heart attack or stroke and often goes undiagnosed until it causes these or other problems.

How is peripheral artery disease diagnosed?

Though 40 percent of people with PAD do not experience symptoms, those who do generally feel leg numbness, cramping, pain or weakness. Other symptoms can include weakness or wounds on the feet or legs that heal slowly, or not at all. Erectile dysfunction is also a red flag that a man may have PAD.  Anyone who has these symptoms should seek an evaluation by a board certified cardiologist.

How is PAD diagnosed?

During a physical examination, the doctor will look for signs such as a weak or absent artery pulse in the extremities, or specific sounds (called bruits) via a stethoscope. He or she will also likely check for changes in blood pressure in the limbs by comparing a blood pressure reading of the brachial artery in the ankle with that or the radial artery in the right arm. Changes in skin and nail changes due to insufficient blood supply (ischemia) will also be checked for. A variety of tests can help diagnosed PAD, as well. These are:

• Doppler ultrasound. The doppler ultrasound uses sound waves to produce images and pictures to help assess the arterial blood flow to the arms and legs. The ultrasound can show where there is a buildup of plaque.  

• Angiography. During this procedure, a long, thin, flexible tube is inserted into the blood vessel either in the arm or the groin and passed through to the neck.  This catheter allows the doctors access to perform procedures on the peripherals. In a typical peripheral angiography, a contrast dye is used to flow through the blood vessels, so they are visible via x-ray images.  This procedure helps detect peripheral artery blockage, a condition in which plaque builds up inside the arteries, causing narrowing and obstruction of blood flow and consequently poor healing.

How is peripheral artery disease treated?

Treatment may include:

• Lifestyle changes (a heart-healthy diet, exercise, and smoking cessation)

• Medication

• Angioplasty and stent placement. This is a procedure performed under IV sedation and entails the insertion of a catheter into an artery. The catheter is then threaded through the arterial system to the coronary artery. The process is aided by special X-ray imaging called fluoroscopy. Next, a thin wire is threaded through the catheter. An expandable balloon is passed over the wire. The balloon is rapidly inflated and deflated to reopen the blocked artery. Angioplasty is often combined with the insertion of a permanent stent. A stent is a collapsed wire mesh tube that is mounted on the angioplasty balloon. When the balloon is inflated, the stent is opened against the artery walls and locked in place to help keep the artery open.

• Atherectomy. This is a procedure in which a catheter with a small cutting device is inserted into the blocked artery to shave or cut off plaque.