Blockages in the arteries can trigger pain from oxygen-starvation. McLeod Vascular Surgeon Gabor Winkler, MD explains diagnosing and treating Peripheral Arterial Disease or PAD.
Here’s a summary of Dr. Winkler’s description:
Peripheral Arterial Disease essentially is a blockage within the artery, which limits the blood flow, causing a decreased amount of oxygen. It is a systemic problem that affects all arteries. It can affect arteries in the neck, in 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: high blood pressure, diabetes, smoking and high cholesterol. A combination of these obviously makes things worse. Probably, the most dangerous combination is diabetes and smoking.
The management of PAD involves a spectrum of treatments. It starts with risk factor modification, medication, minimally invasive procedures (such as balloon angioplasty), and extends all the way up to more invasive procedures (such as a bypass operation).
Testing for PAD starts with the medical history of the patient. We map out the symptoms to 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, the next level testing is what we call non-invasive vascular laboratory testing. That means that there are no pins and needles involved. The simplest test is measuring the blood pressure in the arm and the leg. We calculate 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, we can determine what the level of blockages are in the leg.
The next step involves an ultrasound examination, where we actually look at the arteries and the flow through the arteries. Today’s technology allows us to do this extremely precisely.
The next is an imaging study with contrast material that will map the arteries and allow us to plan an intervention, if needed.
PAD, in general, is a result of lifestyle risk factors that we have control over. Therefore, modification needs to start today for everybody who is at risk. Most patients are able to modify their risk factors to the point, where they can either prevent the symptoms from happening or certainly 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. In these cases usually more invasive treatments are necessary.
Risk factor modification is extremely important to prevent you from getting to that point.