Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD), also known as peripheral vascular disease (PVD), is a type of vascular disease that occurs when arteries in the legs, arms, kidneys or neck become narrowed due to the buildup of fatty deposits and calcium. These narrowed arteries restrict blood flow, which often causes feelings of heaviness and discomfort in the legs. Over time, walking may become difficult.

In severe cases, PAD can lead to limb-threatening situations, such as continuous pain in the feet, poorly healing wounds or even gangrene. Many people with advanced peripheral artery disease face the possibility of amputation if they don’t receive timely and appropriate care.

Scripps doctors are experts at diagnosing the many symptoms of peripheral artery disease. They provide specialized care for the following symptoms and conditions:

• Claudication is the pain, fatigue, weakness, or a feeling of uselessness that can occur in your legs during physical activity such as walking. Symptoms typically begin when you start to exercise, and go away a short time after you rest. Some people also experience tightness, heaviness or cramping in one or both calves, thighs, or buttocks.
• Ischemic ulcers, also known as arterial or vascular ulcers, are open sores that are slow to heal or won’t go away. They often occur on the feet due to poor blood circulation.
• Rest pain, or pain in the feet that is often severe even at rest, is caused by insufficient blood flow to the nerves, due to narrowed or blocked arteries in the legs.
• Infrainguinal occlusive disease refers to narrowing or blockage within a group of arteries in the lower extremities, specifically the femoral, popliteal or infrapopliteal arteries in the legs.

The following conditions are rare among the general population, but have a higher incidence among people who are active, including both amateur and professional athletes. Scripps vascular surgeons are experienced in recognizing and treating these rare peripheral artery disorders:

• Popliteal artery entrapment syndrome (PAES) is a condition that occurs when the popliteal artery (the main artery that runs behind the knee) is compressed by the muscles and tendons near the knee. Compression of this artery causes reduced blood flow to the lower leg, resulting in pain, numbness or cramping in the calf muscle.
• Popliteal artery aneurysm is a bulge in the popliteal artery that runs behind the knee. These aneurysms can result in blood clots that restrict or reduce blood flow to the lower leg.
• Compartment syndrome is a painful condition that occurs when extreme pressure builds within muscles, which decreases blood flow and prevents blood and oxygen from reaching the affected muscles and nerves. Chronic compartment syndrome worsens over time, often in people who run or participate in athletic activities. Acute compartment syndrome, typically caused by a severe injury, is considered a medical emergency.
• Iliac artery endofibrosis refers to leg pain and weakness caused by damage to a group of major blood vessels, known as the iliac arteries, which supply blood to the pelvis, groin and lower legs. The condition is most common in high performance cyclists and can result in significant loss of function.

People with PAD typically do not experience symptoms until later in life because plaque and calcium deposits slowly build up in the arteries over many years. People who smoke tobacco or who have diabetes, however, may develop significant PAD even at younger ages. People with peripheral artery disease may experience no noticeable symptoms, or they may experience one or more of the following:

• Poorly healing or non-healing wounds on the toes, feet or legs
• Lack of healthy blood flow in the feet, legs and arms
• Absence of pulses in the legs, arms or feet
• Painful or heavy muscles in the legs or arms with activity
• Significant pain in the feet and toes while trying to sleep at night
• Onset of gangrene in the feet or legs

Risk factors for peripheral arterial disease can include:

• Family history of vascular disease
• Tobacco use
• Diabetes
• High blood pressure
• High cholesterol
• Age (50 or older)

Scripps physicians can diagnose PAD using one or more of the following tests:

• Ankle/brachial index (ABI), which measures blood pressure at the ankle and arm
• Doppler ultrasound, an imaging study that evaluates blood flow through a blood vessel
• Extremity angiography, a test that uses a special dye used to see the arteries in the hands, arms, feet, or legs
• Computed tomography angiography (CTA), a procedure where contrast dye is placed intravenously (IV) and then used by the CT scanner to create the images of blood vessels
• Magnetic resonance angiography (MRA), a type of MRI that is used to look at blood vessels and the way blood is flowing through them

Our vascular surgeons work closely with other specialists, including interventional cardiologists, to offer a wide range of treatment options no matter how complex your condition. Scripps offers the following open vascular surgery and endovascular surgery to treat PAD:

• Angioplasty and stenting helps inflate and prop open a narrowed artery.
• Drug-coated balloon angioplasty or stenting involves a tiny balloon or stent coated with medication being threaded into the narrowed artery. Once inflated, the balloon flattens the plaque to allow for improved blood flow, while the medication is deposited into the artery wall. The balloon is then removed with only the medication left behind or in the case of stenting, the stent continues to exude the medication for many months. Scripps was the first in California to treat PAD with this procedure.
• Endarterectomy is a surgical procedure in which plaque is removed from an artery so it is no longer narrowed or blocked.
• Vascular bypass surgery is a procedure that allows your surgeon to create a detour around the narrowed or blocked portion of an artery. This “bypass,” made from one of your own veins or from synthetic material, allows blood to flow around the blockage.
• Thrombolysis, or thrombolytic therapy, treats PAD by breaking up clots that have formed inside an artery. Clot-dissolving medication can be injected directly into the blood vessel, or deposited via a catheter that is threaded into the artery. The catheter may also carry a device that can help break up the clot mechanically.

At Scripps, our focus goes beyond treating your arterial blockage. We also aim to reduce other existing risk factors that may continue to affect your vascular health, including high blood pressure (hypertension), high cholesterol, diabetes, tobacco use and poor dietary habits. Serious conditions associated with PAD include heart attack and stroke, among others, so it’s vital to see your doctor if you believe you may be developing or already have peripheral artery disease.

Scripps Health offers comprehensive endovascular and vascular treatment in San Diego at the following locations:

• Scripps Clinic Carmel Valley
• Scripps Clinic John R. Anderson V Medical Pavilion
• Prebys Cardiovascular Institute
• Scripps Green Hospital
• Scripps Memorial Hospital Encinitas
• Scripps Memorial Hospital La Jolla
• Scripps Mercy Hospital San Diego