VASCULAR & INTERVENTIONAL RADIOLOGY
Peripheral Arterial Disease: What It is and How to Treat It
– Dr. Al Benedicto
Peripheral arterial disease (also known as PAD) is a common malady that affects the arteries to the limbs. Atherosclerosis is the most common disease affecting the lower extremity arteries.
The process starts at the endothelial level resulting in vascular injury. The injury results in an inflammatory response and fatty deposition. Repeated insults to the vessel results in scar and plaque deposition that eventually leads to scarring and narrowing of the vessel. Narrowing in the blood vessels compromises blood flow in the circulation bed it delivers, whether it is in the heart or the legs.
PAD is very prevalent even in those people who do not have symptoms. Risk factors that increase your chances of having PAD include: Age | Smoking | Obesity | Being male | Hyperlipidemia Diabetes | Hypertension | Family history
Most patients with PAD have multiple risk factors. The typical patient also presents with diffuse disease in a bilateral distribution. There is a predilection for significant disease processes to affect the vessels at branch point, in particular the distal aorta, common iliac, external iliac, distal superficial femoral, and tibial arteries.
Many of our patients present a variety of symptoms. We classify patients based on the following five categories:
- Asymptomatic – Patients without symptoms
- Classic claudication – Extremity pain confined to the lower leg muscle reproducible with exercise to a determined distance and relief with rest.
- Atypical leg pain – Extremity pain in the lower legs that is exercise-induced but is not reproducible at a determined distance, alleviated with rest, or by limiting daily activity.
- Critical Limb Ischemia – Resting leg pain, nonhealing ulcer or gangrenous tissue.
- Acute Limb Ischemia – The five P’s which threaten the viability of the limb are: Pain | Pulselessness | Paralysis | Paresthesia | Pallor
The diagnosis of PAD can be determined with a patient’s medical history and physical examination as the initial steps. Based on those two factors, the diagnosis can be confirmed with ankle/toe brachial index, pulse volume recording, ultrasonography, computed tomography/magnetic resonance angiography, and contrast angiography.
The scope of treatment is composed of lifestyle modification (weight loss, exercise and smoking cessation), blood and lipid control, and surgical or endovascular revascularization.
Southtowns Radiology is proficient in all of the previouslymentioned imaging modalities. We can provide a timely diagnosis and devise a treatment plan to address the patient’s symptoms.In addition, our vascular and interventional radiologists are experts in diagnosing and treating PAD. We have more than 50 years of combined experience in our vascular section. Our interventional radiologists have undergone an intense training process lasting over 13 years to achieve expertise in the field.