Rahul Arya, MD, is an independent, board-certified vascular and interventional radiologist who chooses to practice at Franciscan Health. He answers your questions and shares expert insight on diagnosing and treating peripheral arterial disease.
A: Peripheral arterial disease (PAD) occurs when cholesterol deposits, known as plaque, narrow and block the arteries that lead to the lower extremities. According to the Centers for Disease Control and Prevention, approximately 8.5 million people in the U.S. have PAD, and it often goes undiagnosed. A key to managing PAD is to manage your risk factors. The leading risk factors for PAD include smoking, high blood pressure, hyperlipidemia, age and diabetes – the same factors that can lead to heart disease and stroke.
A: Mild to moderate spectrum PAD ranges from people who have no symptoms to those who have leg pain during walking or exercise. With severe spectrum PAD, people can have pain at rest. Even more severe disease can lead to ulcerations and non-healing wounds. A superinfection may result which can spread to other areas of the body.
A: Diagnosis and treatment can help with symptoms, help heal wounds and even save patients from amputation. An arterial brachial index (ABI) is a quick, non-invasive screening tool that uses Doppler ultrasound, and can indicate the presence and severity of PAD. If significant disease is present on this screening test, a CT angiogram (CTA) or MR angiogram (MRA) can be performed to determine if it can be treated. Based on the results of these tests, the next step is an angiogram with possible interventions.
A: During an angiogram, we access the artery via the groin and inject contrast dye to evaluate where the disease is located. Based on the findings, an intervention may be performed during the same procedure, or in stages. If there is a significant vascular narrowing, one procedure, atherectomy, basically gently sands down the plaque within the artery. Following this, angioplasty is usually performed, which involves inserting a balloon into the artery and inflating it where the narrowing occurs in order to open the vessel. The balloon is then removed. A stent may be placed to keep the blood vessel open. Newer technology balloons and stents are drug eluting, meaning they deliver medication to prevent the recurrence of blood vessel narrowing.
A: We have had success in delivering significant relief to patients who experience lower extremity symptoms with walking and exercise. In cases of severe disease where patients are unable to get sufficient blood supply to heal their lower extremity wounds, performing these interventions can go a long way toward healing those wounds and even preventing an amputation.