Peripheral Artery Disease (PAD) is a very common disorder which affects almost everyone as we get older. It is the same disease process that causes coronary artery disease and carotid artery disease. The process is a slow “closing off” of the arteries in our body due to plaque formation in the walls of the arteries. This plaque build-up leads to decreased blow flow through the artery. Just like old iron water pipes that would slowly fill up with rust over time cutting off the flow of water, the French fries, fatty foods, bacon and fried eggs, and cholesterol that we put into our systems slowly closes off our arteries. When the blood flow through an artery is reduced or blocked by this plaque, patients develop symptoms and we call it PAD.
The symptoms of PAD vary depending on where in our arterial systems the plaque build-up occurs. Some patients develop hip and buttock pain when walking or exercising. Others may experience thigh or knee pain. The most common symptom is cramping and pain in the calves which occurs while walking. This gets better when we stop and rest, and recurs again when we resume walking or exercise. Very advanced PAD symptoms indicating severe PAD may also occur. This include pain in the calf and foot even when resting, blue cold toes, sores on the foot or ankle that just won’t heal, and cramps at night when laying in bed which get better by hanging the foot off the side of the bed. Most isolated nighttime leg cramps however are not due to PAD. This can be determined by your physician.
Diagnosis of PAD starts with a physical exam. Your physician will check for pulses in the legs and feet. If brisk, strong pulses are present, the pains and leg cramps are probably not from PAD. If the pulses are weak or absent, the next step is to check the BP in the ankles, a simple test called an ABI (Ankle Brachial Index). This test compares the BP in the ankles to the BP in the arms. If there is a big difference then PAD may be present. The next test often performed is a CTA (CT angiogram) of the abdomen and lower extremities. This test may be done at the hospital. It may also be done on the INTEGRIS Heart and Vascular Institutes’ new 64 slice CT scanner. In this test dye is injected into a vein and a CT scan is performed of the abdomen and the legs. This produces a beautiful 3D picture of the entire arterial system and can identify the blockages which may be causing the symptoms.
Once the blockages have been identified by the CTA, the next step is to determine what treatment should be recommended. Every patient is unique. In some cases the best treatment is simply more exercise, especially more walking. This helps the body develop its own small blood vessels, which try to go around the blockage and supply more blood to the hips, thighs and legs.
Other recommended treatments, especially for more advanced PAD, may include surgical options. Depending on exactly where the arterial blockage is, surgical bypass procedures can be performed. We may use an artificial graft, or one of the patient’s own veins to create a new route for the blood (bypass) to go around the blockage. Some of these surgical procedures are called aorta-iliac bypass, aorta-femoral bypass, and the most common, a femoral-popliteal bypass. All of these require anesthesia and a short 3-5 day stay in the hospital, and are performed routinely at INTEGRIS Heart and Vascular Institute.
Today, fortunately, most of these blockages are treated using minimally invasive catheter based techniques. This is called endovascular surgery. Endovascular surgical procedures are done as outpatient procedures, with the patient under light sedation. They are performed in our endovascular suite at INTEGRIS Bass Baptist Health Center. Working through a small catheter placed in the femoral artery in the groin (just like a heart catheterization procedure) the arterial blockages can be treated from inside the artery. This is done using a combination of special endovascular tools which include balloons, stents, cutting devices which remove the plaque, endografts (covered stents), intravascular ultrasound, and others. Patients normally go home the same day and can resume normal activities, including going back to work, in 1-2 days. At the INTEGRIS Heart and Vascular Institute in Enid we perform several hundred of these procedures each year.
To schedule an appointment with Dr. Vanhooser for evaluation of PAD, please call my office at 580-616-7634.
David Vanhooser, M.D.
INTEGRIS Heart and Vascular Institute