Peripheral Artery Disease (PAD)

Peripheral artery disease symptoms

People with peripheral artery disease may not experience symptoms during the beginning stages. The most common early symptom is intermittent discomfort in the legs during activity, including:

• claudication (pain when walking)
• tightness
• heaviness
• cramping
• weakness

With more advanced stages of peripheral artery disease, symptoms may include:

• critical limb ischemia (pain in your feet or toes even when you are at rest)
• painful sores on your feet or toes (left untreated, these sores can become dead tissue, also known as gangrene)

Many people who have peripheral artery disease have pain in their hips, thighs or calves when engaged in physical activity. The pain often goes away when the exercise stops. This is because the leg muscles used in exercise need more blood flow, and this flow is restricted due to the arteries narrowed by the disorder.

Other symptoms can include:

• hair loss on the legs
• slow-healing sores on the lower extremities
• skin changes on the legs and feet
• pain in the toes when at rest or lying flat
• paleness of the legs when they are elevated
• reddish-blue discoloration of the extremities
• thickened or opaque toenails

Peripheral artery disease often goes undiagnosed. It is important to inform a physician if you have symptoms because the condition can lead to increased risk for heart attack and stroke.

Peripheral artery disease treatment at Ohio State

Treatment at Ohio State focuses on controlling symptoms and halting the progression of the disease.

Medication

Medications to lower blood sugar, blood pressure and blood cholesterol may be prescribed. Other medication include those that improve blood flow and relax blood vessel walls. 

Non-Surgical Procedures

Ohio State’s Wexner Medical Center vascular surgeons are experienced in the use of many technologies for minimally invasive treatment of peripheral artery disease including: 

• Angioplasty stenting: A balloon-tipped catheter is inserted into a blocked vessel and inflated, then a small mesh tube is inserted to keep the vessel open
• Cryoplasty: A combination of cold therapy and angioplasty that reduces the risk of restenosis
• Mechanical atherectomy: A device is threaded through a catheter to remove plaque in the blocked area
• Laser atherectomy: Removal of plaque from a blocked artery with the use of a laser
• Pharmacomechanical Thrombolysis: Dissolving a blood clot with the use of thrombolytic (drug) therapy and a catheter that removes the clot from the affected vessel

Surgery

Vascular surgery is for patients with a vascular disease, such as peripheral artery disease, that cannot be treated by less invasive, non-surgical treatments. It may involve endovascular procedure in which catheters (thin, flexible tubes) or stents (mesh-like tubes) are inserted to maintain open arteries or veins. Vascular surgery is also used to redirect blood vessels in patients with poor circulation. 

For patients who cannot be treated with traditional methods, our vascular surgeons participate in ongoing clinical trials investigating new treatments for certain cases of PAD. 

Diagnosing peripheral artery disease

Physical exam and medical history

Your physician will conduct a physical exam, which includes a pulse test that measures the strength of the pulse in the arteries behind your knees and feet. During this visit, you and your physician will also discuss your medical history and what symptoms your have experienced, when they occur, and how often. 

Diagnostic tests

After performing a physical exam and learning about your symptoms and medical history, your doctor may choose to do further testing. Peripheral artery disease can be diagnosed with tests including: 

• Ankle-brachial index (ABI) – A test that determines how well your blood is flowing by comparing the blood pressure in your legs to the blood pressure in your arms
• CT angiogram (CTA - computed tomography angiogram) – An imaging procedure that uses CT technology to produce cross-sectional, detailed images of blood vessels
• Ultrasound – A test that uses high-frequency sound waves to evaluate blood flow in a vessel
• MRA (magnetic resonance angiography) – A noninvasive imaging procedure that uses large magnets, radio frequencies and a computer to evaluate blood flow through arteries
• PPG (photoplethysmography) – An examination that uses a very tiny blood pressure cuff around the toe and an infrared light to evaluate blood flow near the surface of the skin
• PVR (pulse volume recording wavelength analysis) – A technique used to calculate blood volume changes in the legs with a recording device