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    Baylor Plano

    1100 Allied Drive
    Plano, TX 75093
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    Baylor Denton

    2801 S. Mayhill Road
    Denton, TX 76208
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Peripheral Arterial Disease
 
Basic Facts
Peripheral arterial disease (PAD) is a condition where plaque collects in the arteries of the arms or legs clogging or slowing blood flow.
Discomfort in the leg, especially when walking, is the most common symptom of PAD.
The primary cause of PAD is atherosclerosis, or hardening of the arteries.
Peripheral arterial disease (PAD) or arteriosclerosis obliterans, is a condition where plaque collects in the arteries of the legs or, less commonly the arms, clogging or slowing blood flow. The primary cause is atherosclerosis, or hardening of the arteries.

WHAT ARE THE SYMPTOMS?

The symptoms primarily affect one limb, but both limbs can be affected, with the intensity of the symptoms often different in each limb. Discomfort in the leg, especially when walking, is the most common symptom of PAD. The pain may subside when the leg is at rest.

Other symptoms may include:
  • Numbness of the affected limb when at rest;
  • A tingling sensation in the affected limb;
  • Weakness in the affected limb; or
  • A weak or absent pulse in the affected limb
A sore or ulcer that will not heal may develop on the foot or leg in more severe cases.

WHAT ARE THE CAUSES AND RISK FACTORS OF PAD?

The primary cause of PAD is atherosclerosis, or hardening of the arteries. As people age, the normal flow of blood through the arteries can be affected by the buildup of plaque inside the arteries. Over time, plaque continues to grow on arterial walls as cholesterol circulates in the blood; as the plaques enlarge, the arteries become narrow and stiffened. The plaque buildup thickens the walls of the arteries and narrows the space through which the blood flows. When this happens, it reduces the circulation of blood through the area of the body that gets its blood from the artery.

Factors that increase a person's risk for PAD include:
  • Smoking;
  • Age greater than 50;
  • A family history of stroke or heart disease;
  • High blood pressure;
  • High cholesterol;
  • Obesity;
  • Diabetes; and/or
  • Sedentary lifestyle.
DIAGNOSIS

To diagnose PAD, the physician will first obtain a detailed description of the patient's symptoms. The physician may use a stethoscope to listen to the arteries of the affected limb to detect a decreased or absent pulse or listen for a "bruit" or "whooshing" sound caused by turbulent blood flow in a narrowed artery.

Depending on the results of the patient's history and findings from the physical exam, the physician may order the following tests:
  • Ankle/Brachial Index, or ABI (a combination of a traditional blood pressure device and Doppler ultrasound to compare the blood pressure in a person's arms to the blood pressure in their legs);
  • Doppler ultrasound;
  • Computerized Tomography Angiography;
  • Magnetic resonance imaging; and
  • Intra-arterial angiography.
TREATMENT APPROACH

Changes in lifestyle may be enough to slow or stop the progression of PAD for most people. Some of the lifestyle changes that a physician may recommend include:
  • Stop smoking;
  • Lose weight;
  • Exercise regularly under supervision;
  • Eat a low-fat, low-cholesterol diet;
  • Control blood pressure; and
  • Control diabetes
Medications that lower cholesterol or high blood pressure, as well as one that helps improve walking distance (cilostazol), may be prescribed in addition to the lifestyle changes.

For more severe cases, a physician may recommend other treatment methods such as minimally invasive procedures or surgical procedures, including:

An angioplasty balloon catheter inside an artery.
An angioplasty balloon catheter inside an artery.
Angioplasty and Stenting. Angioplasty and stenting are minimally invasive techniques performed using local anesthesia. Angioplasty involves threading a balloon-tipped catheter through an artery in the groin and into the narrowed area of the carotid artery. Inflating the balloon expands the artery, effectively opening it. Today, physicians also insert a stent, a tiny metal mesh tube that serves as scaffolding to hold the artery open, in nearly 100 percent of carotid procedures.

Thrombolysis. Thrombolysis, also called clot-busting therapy, breaks up a blood clot with specialized catheters that either mechanically break up the clot or directly deliver drugs to dissolve blood. This is used when the blockage is caused by a blood clot.

Thrombectomy. A procedure used when symptoms are caused by a blood clot. In thrombectomy, the physician inserts a balloon catheter past the site of the blood clot, inflates it, and removes the balloon, pulling the clot with it.

Surgical Bypass Graft. Surgical bypass improves blood flow by rerouting blood around the narrowed or blocked portion of an artery. During surgical bypass, the surgeon makes a new connection between arteries using a graft vessel, which is made from a portion of a person's own vein or a man-made synthetic-fabric blood vessel. The graft vessel creates a 'detour,' or an auxiliary blood flow route, allowing blood to 'bypass' any blockage.

Medical Review Date: May 10, 2007
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