Medically reviewed by
Dr. Joshua Sibille
McLeod Vascular Associates
Blockages in the arteries can trigger pain from oxygen-starvation. McLeod Vascular Surgeon Dr. Joshua Sibille explains the process of diagnosing and treating Peripheral Arterial Disease or PAD.
“Peripheral Arterial Disease essentially is a blockage within the artery, which limits the blood flow, causing a decreased amount of oxygen,” says Dr. Sibille. “It is a systemic problem that affects all arteries. It can affect arteries in the neck, the chest, in the belly and in the lower extremities.”
The most common symptom is pain — whether it is chest pain when there’s not enough blood supply to the heart, abdominal belly pain when there’s not enough blood supply to the intestines, or leg pain when walking. In other areas, such as the neck arteries that lead up to the brain, symptoms of stroke can also be present.
In general, there are four risk factors for PAD: high blood pressure, diabetes, smoking and high cholesterol. A combination of these can make the condition worse, with the most dangerous being diabetes and smoking.
The management of PAD involves a spectrum of treatments. It starts with risk factor modification, and then progresses to medication and minimally invasive procedures, such as balloon angioplasty. Eventually, this condition may lead to more invasive procedures, such as a bypass operation.
Testing for PAD starts with the medical history of the patient. By evaluating the symptoms, your physician can find out exactly when they occur and what makes them worse. A physical exam, examining all the pulses in the body is extremely important. Then, non-invasive vascular laboratory testing takes place, which is pain-free and does not involve needles. The simplest test is measuring the blood pressure in the arm and the leg. The physician calculates a ratio of the blood pressure in the lower extremity to the one in the arm. Depending on how high or low those values are, the physician can determine what the level of blockages are in the leg.
The next step involves an ultrasound examination, where the arteries and the flow through the arteries are examined. Today’s technology makes this an extremely precise test. This is followed by an imaging study with contrast material that will map the arteries and allow the physician to plan an intervention if necessary.
PAD, in general, is a result of lifestyle risk factors that we have control over. Therefore, modification needs to start today for everyone who is at risk. Most patients are able to modify their risk factors to the point that they can either prevent the symptoms from happening or prevent them from getting worse.
“Many of the patients we see are well beyond the point of risk factor modification and are at the stage called Critical Limb Ischemia, meaning that there is little blood supply to the leg,” explains Dr. Sibille. “In these cases, usually more invasive treatments are necessary. Fortunately, risk factor modification can prevent you from getting to that point.”