Peripheral arterial disease (PAD) occurs when arteries carrying blood to the arms and legs slowly become narrowed or blocked as plaque gradually forms inside the artery walls. The arteries become too narrow or blocked, so blood cannot get through, causing damage and eventually tissue death.
The most common cause of PAD is atherosclerosis or hardening of the arteries. When damage to the artery’s inner lining occurs, plaque builds up. This plaque may crack or tear. When this happens, blood cells called platelets stick to the injured lining, clumping together to form blood clots. This narrows or blocks the arteries, limiting blood flow.
At Cleveland Clinic Florida, many different specialists diagnose and treat PAD.
"We work with colleagues in a variety of fields including vascular medicine, vascular surgery, interventional radiology, and interventional cardiology to provide advanced patient care,” said Kenneth Fromkin, MD, Director of Invasive and Interventional Cardiology at Cleveland Clinic Florida. “This team approach provides for excellent patient care and outcomes."
To diagnose PAD, the doctor will first obtain the patient’s medical history and perform a physical exam. An early indicator is leg pain or cramping, which occurs during an activity such as walking, gets better with rest, but comes back when activity starts again. Other things to look for include burning or aching in the feet and toes pallor of the feet, and infections or sores which don’t heal.
Your doctor will ask about risk factors such as smoking, diabetes, age (those 50 and older have an increased risk), as well as family or personal history of heart or blood vessel disease, high blood pressure, or high cholesterol.
Tests to diagnose PAD include the ankle/brachial index measuring blood pressure in the lower legs compared to the arms. Relatively lower pressure in the legs is a good indication of PAD. Pulse volume recording testing measures the overall blood flow to the legs. Finally, arterial vascular ultrasound emits sound waves which bounce off the artery. These sound waves are recorded, and an image of the vessel is created.
First line treatment is usually a walking program to improve exercise tolerance. This recruits new blood vessels called collaterals which, deliver blood past blocked arteries.. Certain medications may also be used under the supervision of a doctor to reduce symptoms and to improve functional capacity.
When exercise and medication are not enough, a more invasive treatment option is to re-open the blocked vessel with angioplasty and/or stenting. In this procedure, a wire is inserted across the blockage and the doctor inflates a balloon to re-open the vessel. Sometimes a wire mesh stent is also used to prop the vessel open. In other cases, open surgery can be performed to bypass the blockages.
You may schedule an appointment online or by calling toll-free 800.639.DOCTOR.