Peripheral Arterial Disease (PAD)

Saving Limbs Threatened by Atherosclerosis & Diabetes:

Frequently atherosclerosis is not confined to coronary arteries and may involve arteries of other areas. The same atherosclerotic plaque that causes coronary artery stenosis affecting the heart, or carotid artery stenosis affecting the brain, causes peripheral artery disease in the arteries of the limbs. Atherosclerosis causes narrowing of the lower extremity arteries. The results of low blood flow to the legs and can cause muscle cramping after walking. In severe cases it can result in gangrene and limb loss. The symptoms depend on how severely blood flow is reduced and what artery is affected.

Some of the symptoms include:

Claudication:
Dull cramping pain in the muscles of buttocks, thigh or calf on exercise and relieved by rest.
Rest Pain: constant pain in foot due to significant reduction blood flow
Non healing: ulcer of foot or toes
Gangrene
Some of the conditions that aggravate the severity of PAD are called risk factors.

“You have given me 16 years of independence by saving my leg.”

Clara Danowski is a patient from New Jersey who came for a second opinion. After two failed bypasses performed at a local hospital in New Jersey in 1986, she was told that she had to undergo an amputation of her leg. After an evaluation Dr. Shah successfully performed a bypass to one of the small arteries of the leg. Over the last 16 years two more procedures were performed to unclog her bypass. Accompanied by her son, William Danowski happily looks at his mother now 87years old during her recent visit with Dr. Shah.

Iliac Artery Stenosis
78 years old man presented with ulcer over the toe. There was decrease in blood flow due to iliac artery narrowing. The artery was successfully treated by angioplasty and stenting. The ulcer ultimately healed.

Risk factors include:

Smoking, Diabetes, Obesity, High blood pressure, Lack of exercise, Family history of disease

Diagnosis:

Ankle brachial index (ABI):
The non-invasive test done in the vascular laboratory that measures ratio of the blood pressure in your ankle to that in your arm. This ratio may indicate potential vascular problem and degree of vascular compromise.

Ultrasound Doppler test:
This non invasive test uses sound wave to provide image of the blood vessel to determine plaque and/or occlusion
Angiogram:
The test is performed by inserting catheter in the artery of the groin. Special dye is injected and X-ray is obtained to visualize blockage in the artery. This is helpful in planning treatment.

Treatment options:

Risk factor reduction: Cessation of smoking, regular exercise, maintaining ideal weight, controlling blood pressure and diabetes are some of the way to retard progression of disease. 
Medications: Trental and Pletal are two approved medications for claudications. They must be taken under physician's direction.
Angioplasty and stent: Minimally invasive Endovascular treatment involving balloon angioplasty and stenting.
Bypass surgery: Blocked artery is bypassed by vein graft or artificial graft to improve flow to leg and foot.