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Peripheral Artery Disease

Peripheral Artery Disease and Critical Limb Ischemia

Peripheral vascular disease (PVD) affects the arteries, the veins or the lymph vessels. The most severe type of PVD is peripheral artery disease (PAD), which affects the arteries that carry blood to the legs, arms, stomach or kidneys. In PAD, atherosclerosis (hardening of the arteries) causes the arteries to narrow, restricting the amount of oxygen and nutrients flowing to these parts of the body. This disease process is most commonly diagnosed in the legs, yet is similar to coronary artery disease and carotid artery disease.

Understanding Peripheral Artery Disease

More than 10 million people in the United States have PAD. The likelihood of PAD increases with age, diabetes, high blood pressure, high cholesterol level or smoking. For instance, by age 65, about 10-15 percent of the population has PAD, of which a significant number of patients are symptomatic. Diagnosis is critical, as patients with PAD have a four- to five-fold higher risk of heart attack or stroke.

Symptoms of PAD depend on which arteries are affected and how severely the blood flow is reduced. In the legs, moderate reduction on arterial blood flow results in muscle cramps with walking, also known as claudication. As arterial blood flow reduction becomes more severe, patients may experience constant pain, numbness or tingling of the feet, and develop non-healing sores or gangrene of the feet. This more severe form of PAD is known as critical limb ischemia, and intervention is essential to avoid major amputation.

Your doctor may rely on the following tests to diagnose PAD in the legs:

  • physical examination to document the quality of the peripheral pulses, and to assess the affected limb for ischemic sores or gangrene

  • ankle brachial index (ABI) to measure blood pressure at the ankle and in the arm while a person is at rest

  • ultrasound Doppler and/or angiography (CT scan or MR scan using contrast dye intravenously) to view blood flow in the arteries of the legs in order to locate the segments of narrowed or occluded arteries.

Treating Peripheral Artery Disease

Treatments typically include lifestyle changes, medication, walking exercise, balloon angioplasty and stenting , bypass surgery, or a combination of these therapies.

Although lifestyle changes, medication and walking exercise don’t eliminate the narrowing of the arteries, they can help improve the efficiency of the heart and leg muscles and reduce symptoms such as leg pain, cramping, and weakness. Patients diagnosed with PAD are at increased risk of stroke and heart attack, and our vascular surgeons will work with your healthcare team to control your cardiovascular risk factors.

Vascular surgeons at the Washington University and Barnes-Jewish Heart & Vascular Center are nationally recognized for their skill in minimally invasive procedures. Working through a slender catheter placed in the artery at the groin or the elbow, our surgeons can restore blood flow to the legs with minimal discomfort and a short recovery time. In fact, many of these procedures are performed on an outpatient basis. Treatment options include:

  • percutaneous transluminal angioplasty (balloon angioplasty or PTA)

  • stent and covered-stent placement

  • atherectomy devices

In 2013, the FDA approved the use of a drug-eluting stent in the treatment of PAD. For many years, physicians have used drug-eluting stents in the small arteries of the heart with excellent results. The same technology can be used to improve the outcomes of stent placement in the thigh artery, the most common location of blockages due to PAD. The device is implanted in the artery using a slender catheter that is introduced at the groin area. This outpatient procedure does not require a surgical incision or general anesthetic.

In addition, participation in clinical trials allows our surgeons to provide patients with unique access to the latest experimental techniques of endovascular treatment, pharmacologic therapy, and biologic intervention.

In certain settings, arterial bypass surgery may be required to correct severe, extensive blockages of the pelvic and leg arteries. In bypass procedures, our surgeons utilize a superficial leg vein or synthetic conduit to redirect blood flow around the blockages in the leg arteries. In some cases, combined procedures utilize both open surgical and endovascular techniques to achieve successful restoration of blood flow to the lower extremities, thereby reducing the recovery associated with bypass procedures.

Achieving the best results in treating critical limb ischemia often requires the efforts of different teams of caregivers- vascular surgeons with endovascular and surgical skills, podiatrists, wound care specialists, and more. The multidisciplinary Limb Salvage Center at the Washington University and Barnes-Jewish Heart & Vascular Center focuses these resources on our patients, helping them to best maintain their comfort, mobility, and independence.

To make an appointment with a Washington University heart or vascular specialist at Barnes-Jewish Hospital, call 855.925.0631.