Peripheral Arterial Disease

What Is Peripheral Arterial Disease?

Peripheral arterial disease (PAD) is generally associated with blocked arteries of the legs. The blockage most often is the result of a chronic buildup of hard fatty material (atherosclerosis or hardening of the arteries) into the inside lining of the arterial wall of the legs. This ultimately narrows and blocks the flow of blood which carries oxygen and nutrients to the limb. The femoral and popliteal arteries are the major arterial blood supply to the lower extremities and are a common location for atherosclerotic disease to develop.

The presence of atherosclerosis in the leg arteries is a strong indicator that there is also atherosclerosis in the arteries of the heart and brain, because atherosclerosis is a widespread disease of the arteries. Atherosclerosis of the leg arteries may cause a blockage, obstructing blood flow, and potentially result in pain in the leg(s), ulcers or wounds that do not heal, and/or the need for amputation (surgical removal) of a foot or leg. Therefore, PAD has two major complications associated with its presence: limb complications (nonhealing wounds, ulcers, gangrene, loss of a limb) and risk for stroke and/or heart attack.

Peripheral arterial disease caused by atherosclerosis may be present with symptoms or without symptoms. The presence of symptoms may depend on the degree to which blood flow to the leg muscles has been decreased. Symptoms may range from mild to moderate to severe.

Symptoms of Peripheral Arterial Disease

The most common symptom of peripheral arterial disease is called intermittent claudication. Claudication refers to limping because of pain in the thigh, calf, and/or buttocks that occurs when walking. The pain or discomfort of claudication starts with walking or exercise and stops with rest. Walking or exercise increases the demand for oxygen and nutrients needed for the leg muscles to do work. Decreased blood flow through the affected artery of the leg(s) due to narrowing or occlusion (blockage) decreases the amount of oxygen and nutrients to the muscles and may result in pain. This symptom is reproducible (the same exercise, at the same pace, and the same distance, will reproduce the same symptom), which is helpful in diagnosing the condition. Just as chest pain or angina of the heart can signal a heart attack, intermittent claudication may be considered as "angina of the legs" and may indicate lack of blood flow to the legs.

Other symptoms of peripheral arterial disease may include, but are not limited to, the following:

  • Cool/cold feet to touch
  • Pain in the legs while lying flat and relieved by a sitting position
  • Loss of pulses in legs or feet
  • Pale color when legs are raised up
  • Dependent rubor (redness when legs are in a dependent [hanging down] position)
  • Shiny skin
  • Loss of hair on feet
  • Thickened toenail (may have fungal infections)
  • Non-healing wound or ulcer
  • Gangrene
  • Loss of muscle or fatty tissue

The most severe symptom of peripheral arterial disease caused by atherosclerosis is called critical limb ischemia (lack of oxygen to the limb/leg at rest). Critical limb ischemia (CLI) is defined as pain in the leg(s) while at rest, or "rest pain." CLI is also associated with the breakdown of tissues (muscle/skin) in the form of ulcers or gangrene in the limb, which may occur because blood flow to the limb is so decreased that the basic needs of the limb for oxygen and nutrients are not being met. Critical limb ischemia may include some or all of the symptoms of peripheral arterial disease as well.

Because peripheral arterial disease is associated with the two other major atherosclerotic conditions, coronary artery disease (heart disease) and cerebrovascular disease (stroke), treatment may range from management of risk factors to surgical procedures. The same risk factors that may contribute to a heart attack or stroke are the same for peripheral arterial disease.

These include, but are not limited to, the following:

  • Smoking (tobacco)
  • Diabetes
  • Hypertension (high blood pressure)
  • Hyperlipidemia (high blood cholesterol)
  • Family history of atherosclerosis

Peripheral Arterial Disease Treatment

Robert Wood Johnson University Hospital (RWJUH) vascular surgeons perform both open surgical revascularizations and minimally-invasive endovascular treatments for PAD. Endovascular treatments such as angioplasty and stenting for the treatment of PAD have been increasingly utilized at our institution as these new devices become available.

The surgeons at RWJUH are experts in both open and endovascular treatment for PAD and perform over 300 procedures annually in both the elective and emergency settings.

Our surgeons perform both open and endovascular procedures in the operating room. Thanks to an increase in new minimally invasive technology for the treatment of PAD, RWJUH offers treatment of advanced disease, with few resulting complications, a shorter hospital stay, and decreased recovery time.

RWJUH serves as the tertiary care facility for all of central New Jersey, and is frequently asked to perform limb salvage procedures on patients who have been turned away by many area hospitals and surgeons.

All of the following procedures are performed by our surgical experts:

Open Surgical Revascularization

  • Aortic Endarterectomy
  • Aorto-iliac Bypass
  • PolarCath Cryoplasty
  • Femoral-Popliteal Bypass
  • Femoral- Tibial Bypass
  • Femoral Endarterectomy
  • Pop-Tibial Bypass

Endovascular Procedures

  • Diagnostic Angiography
  • Balloon Angioplasty
  • Stenting
  • Atherectomy (Silverhawk, Laser)
  • Chemical Thrombolysis (TPA)
  • Mechanical Thrombolysis (Angiojet, Trellis)

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