Peripheral Artery Disease (PAD)


What We're Up Against

Peripheral Artery Disease (PAD) is a common circulatory problem in which plaque builds up inside the arteries and obstructs blood flow to the lower limbs and feet. Patients who develop PAD usually notice hip, leg or calf pain (called "claudication") when walking. This pain occurs because the peripheral arteries are not able to deliver enough blood flow to the surrounding muscles. Though PAD, by definition, refers to the peripheral arteries, the process of atherosclerosis (the widespread accumulation of arterial plaque) is systemic and affects the entire body. Approximately 40-60% of patients with PAD also suffer from coronary artery disease.

 

Signs and Symptoms of PAD

  • Painful cramping in your hip, thigh or calf muscles after walking or climbing stairs
  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared to the other leg
  • Sores on your toes, feet or legs that will not heal (especially a black/discolored toe)
  • A change in the color of your legs
  • Hair loss on your feet and legs

If undiagnosed and / or untreated, PAD can lead to leg pain while resting or lying down. This pain may be intense enough to disrupt sleep. In more advanced cases, PAD can lead to the development of non-healing ulcers, or open sores that do not heal, as well as injury or infection of your feet and legs, especially if you have diabetes. Critical limb ischemia (CLI) is the extreme state of this condition and can cause tissue death (gangrene), which sometimes requires amputation of the affected limb.

 

Risk Factors

  • Smoking
  • Diabetes
  • Obesity (defined as body mass index over 30)
  • High blood pressure (140/90 millimeters of mercury or higher)
  • High cholesterol (total blood cholesterol over 240 milligrams per deciliter or 6.2 millimoles per liter)
  • Increasing age, especially after reaching 50 years of age
  • A family history of peripheral artery disease, heart disease or stroke
  • Excess levels of homocysteine, a protein component that helps build and maintain tissue
  • Excess levels of C-reactive protein (CRP), a general marker of inflammation

Diagnosis

Common tests your physician may rely on to diagnose peripheral artery disease include:

Physical Exam: Your physician may find signs of PAD during a physical examination, such as a weak or absent pulse below a narrowed area of your artery, "whooshing" sounds (bruits) over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb.

Ankle-Brachial Index (ABI): ABI is considered to be one of the most common tests used to diagnose PAD. The ABI test compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your physician uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may be asked to walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.

Ultrasound: Special ultrasound imaging techniques such as Doppler ultrasound or duplex scanning can help your physician evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.

Angiogram: By injecting a dye (contrast material), your physician is able to trace the flow of the contrast through your arteries in order to determine the level of blood flow. The physician may use imaging techniques such as X-ray, Magnetic Resonance Angiography (MRA) or Computerized Tomography Angiography (CTA). An angiogram is a minimally invasive procedure.

Blood Tests: A sample of your blood can be used to measure your cholesterol and check levels of homocysteine and C-reactive protein (CRP).

Treatment Options

Balloon Angioplasty

To open a narrowed artery, a catheter with a very small balloon on its tip is placed in the artery and is advanced to reach the narrowed or blocked artery. The doctor then inflates the balloon, pushing aside the plaque that has built up against the vessel walls. The doctor then inflates and deflates the balloon several times to open the vessel. 

Amputation

An amputation is a procedure where a physician removes a limb, or part of a limb, that is causing great pain or is threatening a patient's health because of extensive infection. Most commonly, a toe, foot, leg, or arm is amputated. PAD is the leading cause of amputation in people age 50 and older. 
Atherectomy

Atherectomy is a minimally-invasive method of removing plaque to re-open arteries. Unlike angioplasty and stenting which are designed to squish plaque to the side, atherectomy involves cutting and removing the plaque from the artery, restoring normal blood flow.

Bypass

Surgical bypass treats narrowed arteries by directly creating a detour, or bypass, around a section of the artery that is blocked. During a bypass procedure, a physician creates a new pathway for blood flow using a graft. A graft can be a portion of a vein or a synthetic tube that connects above and below a blockage to allow blood to flow around it.

Stenting

A stent is a small, metal scaffold that is placed inside an artery. Similar to balloon angioplasty, stents restore blood flow by pushing the plaque to the side but remain inside the artery forever. Stenting often follows balloon angioplasty as an additional treatment to help the vessel remain open.

Frequently Asked Questions

  • What is Peripheral Artery Disease?
  • What is the difference between PAD and PVD?
  • What are the signs and symptoms of PAD?
  • What risk factors are associated with PAD?
  • Will my physician automatically screen for PAD?
  • What is a Chronic Total Occlusion?
  • Can my physician treat a Chronic Total Occlusion (CTO)?
  • What are Wildcat's indications and contraindications for use?
  • Is there any training required to use this technology?
  • Are physicians in my area using Wildcat?

Q: What is Peripheral Artery Disease?

Peripheral Artery Disease (PAD) is a common circulatory problem in which plaque builds up inside the arteries and obstructs blood flow to the lower limbs and feet. PAD is one of the most common cardiovascular diseases, affecting 5 - 12 million Americans. Patients who develop PAD usually notice hip, leg or calf pain when walking (claudication). This pain occurs because the peripheral arteries are not able to deliver enough blood flow to the surrounding muscles. Though PAD, by definition, refers to the peripheral arteries, the process of atherosclerosis (the widespread accumulation of arterial plaque) is systemic and affects the entire body. Approximately 40% – 60% of patients with PAD also suffer from coronary artery disease and cerebral artery disease.

Q: What is the difference between PAD and PVD?

PAD stands for Peripheral Artery Disease and PVD stands for Peripheral Vascular Disease. They are often used interchangeably. 

Q: What are the signs and symptoms of PAD?

Many people with progressing PAD have no symptoms at all, so it is important to talk to your physician about your risk factors.   Common PAD symptoms include:

  • Painful cramping in your hip, thigh or calf muscles after walking or climbing stairs (claudication)
  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared to the other leg
  • Sores on your toes, feet or legs that will not heal, especially a black/discolored toe
  • A change in the color of your legs
  • Hair loss on your feet and legs

Q: What risk factors are associated with PAD?

Factors that increase your risk of developing PAD include:

  • Smoking
  • Diabetes
  • Obesity (defined as body mass index over 30)
  • High blood pressure (140/90 millimeters of mercury or higher)
  • High cholesterol (total blood cholesterol over 240 milligrams per deciliter or 6.2 millimoles per liter)
  • Increasing age, especially after reaching 50 years of age
  • A family history of peripheral artery disease, heart disease or stroke
  • Excess levels of homocysteine, a protein component that helps build and maintain tissue
  • Excess levels of C-reactive protein (CRP), a general marker of inflammation
  • African American and Hispanic decent

Q: Will my physician automatically screen for PAD if I have a family history of Coronary Artery Disease and PAD risk factors?

Although your physician is continually monitoring your health, you may need to request that your physician screen you for PAD.

Some of the tests your physician may rely on to diagnose peripheral artery disease include:

Physical Exam

Your physician may find signs of PAD during a physical examination, such as a weak or absent pulse below a narrowed area of your artery, "whooshing" sounds (bruits) over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb.

Ankle-Brachial Index (ABI)

ABI is considered to be one of the most common tests used to diagnose PAD. The ABI test compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your physician uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may be asked to walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.

Ultrasound

Special ultrasound imaging techniques such as Doppler ultrasound or duplex scanning can help your physician evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.

Angiography

By injecting a dye (contrast material) into your blood vessels, your physician is able to trace the flow of the contrast material through your arteries in order to determine the level of blood flow. The physician uses imaging techniques such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). Catheter angiography is a minimally invasive procedure. Your physician inserts a catheter through an artery in your groin and guides it to the affected area, and then injects dye through the catheter in order to obtain a picture of the vessels and arteries in the affected area. This type of angiography allows for simultaneous diagnosis and treatment.

Blood Tests

A sample of your blood can be used to measure your cholesterol and check levels of homocysteine and C-reactive protein (CRP).

Q: What is a Chronic Total Occlusion?

A complete blockage of an artery

  • Typically described as >99% stenosed
  • Duration >3 months
  • Responsible for clinically significant decrease in blood flow

Q: Can my physician treat a Chronic Total Occlusion (CTO)?

The treatment of CTOs involves a fundamental understanding of the management of PAD in general. The level of occlusive disease can often be determined based on history and physical examination, including an ankle brachial index.

Q: What are Wildcat's indications and contraindications for use?

Indications

The Wildcat Catheter is intended to facilitate the intraluminal placement of conventional guidewires beyond stenotic lesions (including sub and chronic total occlusions) in the peripheral vasculature prior to further percutaneous intervention. 

Contraindications

The Wildcat Catheter is contraindicated for use in the iliac, coronary, cerebral or carotid vasculature.

Q: Is there any physician training or staff training required in order to use this technology?

One of the many benefits of Wildcat is that it is very user-friendly and intuitive. As a first step, the local Avinger sales consultant will briefly in-service the physician and their staff on Wildcat techniques and how to flush and prep the device for best usage. Avinger also offers a wide variety of educational opportunities to help physicians and staff become more confident and competent crossing CTOs using Wildcat.

Q: Are physicians in my area using Wildcat?

Physicians currently using Wildcat can be found through our Find a Physician search feature, located in the module at the bottom of this page. 

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