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Through a series of prompts, the ChristianaCare COUGH & COLD LINE will provide helpful info on how best to manage your cold, flu and COVID-19 symptoms at home. We’ll also guide you on when you should seek care.

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Vascular Health

Peripheral Arterial Disease

Constricted blood flow to the lower extremities

About Diagnosis FAQ Lower Your Risk Consultations

About Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is the narrowing or blockage of arteries, which limits blood flow to the lower extremities. PAD is a condition you’ll have for the rest of your life. Although there’s no cure for PAD, you can manage the symptoms — especially when a health provider finds the disease early. Lifestyle changes, medications and other treatments can greatly reduce symptoms and slow or prevent the progression of the disease.

What is Peripheral Arterial Disease (PAD)?

Peripheral arterial disease (PAD) occurs when arteries outside of your heart or brain narrow. PAD most commonly refers to narrowing of the arteries in your lower limbs. The most common cause of PAD is the buildup of plaque in the arteries that obstructs blood flow to the muscles and organs, a condition called atherosclerosis. About 10 to 14 million people in the U.S. suffer from PAD, and the disease is equally likely to affect both men and women.

How is Peripheral Arterial Disease Diagnosed?

To diagnose PAD, you will first undergo a short physical exam, including a discussion about your symptoms and your lifestyle. Blood tests may also be required to check your cholesterol, triglyceride and blood sugar levels.

Your doctor may also wish to order some imaging tests to better understand the blood flow in your extremities. Blood tests could include:

Ankle-brachial index: A test that compares blood pressure in your arms and legs.
CT angiography (CTA): A test that uses a contrast material (dye) and a series of X-rays to provide detailed cross-section images of your arteries.
Duplex ultrasound: A test that shows the artery, measuring blood flow and revealing potential blockages through imaging created by sound waves.
MR angiography (MRA): A test that shows clear cross-sections of your arteries using a strong magnetic field instead of X-rays.
Peripheral angiogram: A minimally invasive test that uses a camera mounted on a catheter – a long and narrow tube – inserted into the artery that provides doctors a direct view of blockages.

Frequently Asked Questions

When the arteries in the leg are narrowed by the build up of plaque, the lack of blood flow causes a condition called ischemia. Ischemia occurs when there is less oxygen in the blood than needed. The most common symptom of ischemia is claudication – a cramping of the legs and buttocks when you walk. This kind of intermittent claudication is seen in about 40-50 percent of patients diagnosed with PAD. Other symptoms include:

Numbness or coldness of the feet.
A loss of hair around the ankles.

Claudication can also cause a series of symptoms to occur:

Cramping and pain while walking leading to a more sedentary lifestyle.
Less calories getting burned causing weight gain.
A gain in weight causing an increase of low-density lipoprotein (LDL) cholesterol, blood pressure and other risk factors of heart disease.

People with PAD may be at risk of the following complications:

Heart attack.
Stroke.
Transient ischemic attack (TIA) — also known as a “mini-stroke.”
Erectile dysfunction.
Infection.
Gangrene, treated by amputation, caused by inadequate blood supply to the affected limb.

Call your health care provider when you have leg pain, numbness or any of the other symptoms associated with peripheral artery disease. It’s better to stay on top of your health than to miss potential issues before they worsen.

Here are some questions you can ask your doctor:

Do I need medications to reduce my risk of PAD?
Are my lifestyle choices compatible with a healthy future?
How far should I walk when I start a walking program? Do I need surgical intervention for PAD?

If you can’t feel or move your foot, or if the skin color of one foot looks different from the other foot, you’ve likely lost blood flow to your leg without warning. Get immediate help at an emergency room or urgent care facility.

A diagnosis of PAD is serious and carries significant risk of illness and death. Anyone diagnosed with PAD should immediately be put on the best medical therapy available to them. Treatment for PAD depends on the symptoms the patient experiences.

The goal of PAD treatments is generally to reduce symptoms, reduce the risk of losing a limb or life-threatening cardiovascular events such as a heart attack or stroke and generally improve quality of life. Treatments for PAD include:

Lifestyle Changes: Simple changes to your lifestyle can help relieve symptoms and prevent the development of cardiovascular disease. Some changes may include:
- Quitting smoking.
- Getting regular exercise.
- Eating a heart-healthy diet.
- Controlling your blood sugar levels.
- Taking care of your feet to prevent ulcers and infection.
- Maintaining a healthy weight.
Medications: Certain medications can greatly help reduce symptoms and prevent complications. Medications may include:
- Antiplatelet drugs: These can reduce the risk of blood clots, lowering the risk of heart attack and stroke. Medications like aspirin or clopidogrel may reduce PAD symptoms and increase the distance people with lower extremity PAD can walk.
- Cliostazol: Can reduce leg and buttocks pain, increasing the distance people with lower extremity PAD can walk.
- Statins: Can reduce cholesterol levels, slow the progression of atherosclerosis, reduce the risk of complications from PAD and lower the risk of cardiovascular disease. Statins are recommended to patients regardless of whether they are experiencing problems with their cholesterol.
Endovascular Intervention: A minimally invasive procedure that uses X-ray guidance to advance imaging, wires, catheters and dedicated devices that can be used to open up blockages and improve blood flow to the limb. Endovascular treatment techniques include:
- Angioplasty: A catheter with a balloon at its tip is guided to the narrowed or blocked artery segment and inflated, reopening the artery and restoring blood flow. Optionally, the balloon may be coated with medication to prevent re-narrowing. After the procedure, the balloon and catheter are withdrawn.
- Stenting: A mesh tube, known as a stent, is placed into the narrowed artery to maintain its openness post-angioplasty, especially if the artery tends to re-narrow quickly. Stents can also be medicated to prevent re-narrowing.
- Atherectomy: This minimally invasive procedure removes plaque buildup in an artery. A catheter with a rotating blade, burr or laser is inserted into the affected artery to eliminate or vaporize plaque.
Surgical Procedures:
- Arterial Bypass Graft: Redirects blood flow around narrowed or blocked sections of an artery using a graft placed above and below the affected area. Grafts are typically veins or man-made tubes, allowing unimpeded blood flow past the obstruction.
- Endarterectomy: Involves surgically removing plaque buildup from a narrowed or blocked artery. After making an incision and opening the artery, the surgeon removes the plaque and widens the artery using a bioprosthetic material, reducing the likelihood of future narrowing.

Sometimes, both endovascular and surgical procedures are necessary to treat PAD; this is known as a hybrid approach. The decision to perform surgery depends on the symptoms being experienced, as well as the goals of treatment. The general approach is as follows:

Patients with no symptoms typically don’t require endovascular intervention or surgery.
Patients experiencing claudication should be treated with medications first. Following this, if their symptoms have a significant effect on their lifestyle, intervention or surgery to improve blood flow may be needed.
Patients with CLTI, pain in their feet even when resting or wounds that don’t heal within a month should pursue the above surgical and endovascular treatment options to avoid the need for major amputation one day.

How Can I Lower My Risk of PAD?

The same advice that applies to maintaining heart health applies to maintaining healthy circulation. A few things you can do to reduce your risk of getting PAD are:

Manage your weight.
Eat a low-fat, low-sugar diet — including plenty of fresh fruits and vegetables every day.
Don’t use tobacco products.
Exercise at least 30 minutes a day on most days of the week — with your doctor’s approval.
Make sure you maintain a relationship with your Primary Care Provider and attend appointments as advised.
Be sure to take any prescribed or recommended medications too.

Know the warning signs and maintain a healthy lifestyle. Above all, know when to ask for help. Contact us for more information or to schedule an evaluation.

Interested in a Consultation?

Speak with your primary care provider about your symptoms, and they may refer you. Or reach out to us directly and we’ll put you in touch with one of our vascular surgeons.

ChristianaCare Vascular Specialists

Center for Heart & Vascular Health
4755 Ogletown-Stanton Road
Suite 1E20
Newark, DE 19713

Get directions and find out more

Call 302-733-5700, prompt 2