Peripheral Artery Disease

Conditions and Procedures
What is the condition of

Peripheral Artery Disease

Peripheral Artery Disease (PAD) is a condition where the arteries that supply the legs or arms become narrowed or blocked. This usually occurs because of build of fat and cholesterol in the walls of arteries resulting in narrowing of the arteries. This, in turn, results in decreased blood flow to legs or arms.

What symptoms can it cause

This may result in symptoms or may not have any symptoms at all. If symptomatic, the blocked vessel can result symptoms that range from mild to severe. This in turn depends on the extent of disease and how quickly the disease gets worse.

In the mildest form, the narrowed vessel may decrease the bold supply to the leg when exercising resulting in calf pain (claudication). This pain is typically relieved with rest. As the arteries become increasingly blocked, the blood flow can be severely restricted resulting in pain in the foot at rest (rest pain), ulcers or even gangrene. At this point, there is significant risk of losing your leg if an operation is not performed.

What treatments are available for

Peripheral Artery Disease

The treatment options are dependent upon the severity of symptoms, where the disease is and the extent of disease. Dr Altaf will take a full history and examination to look at all the co-morbidities to decide what treatment would be recommended. The options include:

Medical management

The choice of medical treatment depends on the presentation and the patient co-morbidities.  You are likely to be started on a blood thinner, something to control your cholesterol and blood pressure. Other risk factors that would also be managed include stopping smoking, losing weight and exercising.

Peripheral endovascular management

Endovascular operations or ‘keyhole’ surgery are minimally invasive procedures that are used to open up blocked arteries of the legs or arms. A small tube is placed in the groin artery and dye is injected to identify the blockages in the arteries. Then the blockages can be treated by one or more of the following methods:

Angioplasty

Through the tube inserted in the groin, a balloon is advanced through the blockage. The balloon is then dilated to enlarge the narrowing of the artery sufficiently to improve blood flow.

Stent

Sometimes a stent will be placed in the artery to keep the artery open for the blood flow to continue. A stent is usually used in conjunction with a balloon to expand the stent.

Atherectomy

Atherectomy is a type of ‘drill’ that opens up very tight blockages in the vessel. This novel device is usually used with a balloon angioplasty or stent to keep the vessel open.

Open Surgical Techniques

Sometimes the type and extent of the disease makes endovascular treatment difficult and open surgery may prove to be more superior. Open surgery requires a hospital admission for several days and may require an ICU admission.

Endarterectomy

An endarterectomy involves opening the artery surgically and removing the blockage physically. The artery is cleaned out and closed over with a patch (usually with a bit of vein).

Surgical bypass

A bypass is used to improve the blood supply of the leg by using a graft (usually a vein from the leg or a plastic tube).