Arteries below the heart usually do not get as much attention as those leading to heart and brain. These peripheral arteries that do not supply blood to the heart and brain can become clogged just like coronary arteries.
If there is a blood-flow blockage in your leg arteries due to plaque buildup, the condition is known as peripheral artery disease or PAD. Plaque is made up of fat, cholesterol, calcium, fibrous tissue and other substances in your blood. The process of plaque buildup in arteries is known as atherosclerosis. Over a period of time, the plaque hardens and narrows the artery, resulting in reduced blood flow. Plaque can develop in the arteries leading to your heart, head, kidneys or stomach, reducing the supply of blood to these organs. When blood flow is blocked in the arteries of your legs, it results in peripheral artery disease or PAD.
Prevalence of PAD
One in 20 Americans over the age of 50 has peripheral artery disease. PAD affects 10% of the American population with 30% to 40% having claudication symptoms. Claudication is pain that most often occurs in legs while exercising due to little blood flow. However, not all patients show PAD symptoms, most of the individuals remain asymptomatic unless the disease becomes advanced.
Approximately 50% of the PAD patients are asymptomatic, making it difficult to diagnose the disease at an early stage of its progression. Large vessel peripheral artery disease increases dramatically with age, and is more common in men than women. 30% to 50% of patients with PAD have evidence of coronary artery disease or heart disease.
Tests to Diagnose Peripheral Artery Disease
Blood pressure measurement done to check the problems with peripheral arteries is known as Ankle-Brachial Index or ABI. Pressure in the arteries in the crook of the arm which is close to heart is used to measure blood pressure elsewhere in the body. However, when blood has to pass through clogged artery pathways, blood pressure at the sites away from the heart, such as legs, can differ from that of the arm.
An ABI compares the blood pressure of the arms and legs. The results can signify the presence or absence of peripheral artery disease. Your doctor or nurse will measure blood pressure in your arm and ankle arteries. There are many methods of calculating ABI. One method involves recording the highest pressure at the ankle and dividing it by the highest pressure at the brachial artery located in the upper arm.
Ankle-Brachial Index to Detect PAD
The normal range of ABI is 0.9 to 1.3. An ABI of less than 0.9 means blood is having a hard time travelling through the narrowed artery. ABI of 0.41 to 0.90 indicates mild to moderate peripheral artery disease. Those with diabetes and chronic kidney disease may have ABI of 1.30 or more which is usually the sign of stiff, calcium-encrusted arteries. Toe brachial index might be a better approach for such patients as toe arteries rarely get calcium deposits. ABI of 1.3 represents stiffed arteries that may or may not be blocked.
ABI of 0.7 or less is indicative of significant PAD. However, in patients with severe arterial wall calcification, ABI could not diagnose PAD. As such, your doctor may decide to perform a special ultrasound, known as Doppler Ultrasound, which visualizes arteries with sound waves and evaluates blood flow. This ultrasound may record special waveforms that the specialist may interpret to get ABI number and other important information. CT or MRI may be conducted if an abnormality is detected in ABI or ultrasound.
Angioplasty for PAD Treatment
Angioplasty is another technique to detect artery blockages. It uses a dye or a contrast material which is injected into the blood vessels to allow the doctor to view the blood flow as it happens. The flow of dye is visible with the help of X-ray imaging techniques, such as Magnetic Resonance Angiography (MRA) or Computerized Tomography Angiography (CTA). This is useful to determine the location, type and extent of blockage in the artery.
Catheter angiography involves guiding a catheter (a thin tube with camera) through an artery in your groin. It allows simultaneous diagnosis and treatment of a narrowed artery as your doctor can widen it with the help of a balloon and placing a stent.
Frequently, PAD is asymptomatic at the beginning, which means patients often report no physical leg symptoms. Asymptomatic PAD is common, and can go unnoticed for some time. People with asymptomatic PAD should restrict physical activity to avoid leg pain.
Management of PAD in patients with intermittent claudication should focus on the risk factor modifications such as tobacco cessation, controlling blood sugar, high blood pressure and aspirin therapy whenever indicated.
PAD patients have a higher risk of stroke or a heart attack. The presence of PAD in patients with the coronary arterial disease (CAD) is associated with adverse cardiovascular outcomes and progressive atherosclerosis. Improved PAD detection is crucial for effective cardiovascular prevention and treatment.
What is Balloon-Stenting?
Once the type, extent and blockage have been determined, a catheter will be guided to the blockage along with a balloon and stent over it. Stents are usually made of wire mesh and may be coated with a drug to prevent any damage to the artery wall. The stent delivery system will be carefully moved to the blockage site, and on reaching the blockage, the balloon will be inflated that will expand the stent in the process.
The process moves the artery walls away and firmly places the stent there. Once the stent has been successfully placed, the balloon will be deflated, and the guide-wire, balloon and catheter will be taken out from the nick in your groin. The stent will be left there that will serve as a scaffold, ensuring regular blood flow thereafter.
After your non-surgical peripheral artery disease treatment, you will be moved to an observation room where your condition will be monitored to ensure that there are no post-procedure complications. Almost all of our patients are discharged within 24 hours of the procedure. You will be given some medications to be taken at home. Take all your medications as prescribed. You should be able to begin your normal activities within a week of the procedure as it has a fast recovery.
Schedule Your Appointment with a Specialist
You can discuss your PAD complications and PAD symptoms with our specialist, who may evaluate you further if needed to diagnose your PAD symptoms and suggest you the best course for PAD treatment based on your specific medical condition. We have clinics all over the USA including New York, California, Massachusetts, Florida and Georgia.
To schedule your appointment with one of our specialists, please call us at 888-773-2193, or schedule an appointment online.