Peripheral Arterial Disease (PAD), also known as peripheral arterial disease affects the circulation of both the upper and predominantly lower extremities. People with PAD have areas of narrowing or blockages of their arteries which prevent adequate circulation in the affected body part. About 10 million people in the United States are afflicted with PAD every year. Tobacco use, high cholesterol, high blood pressure, and diabetes increase an individuals risk for developing PAD.
The most common symptom of PAD is a cramping pain in the legs, hips or buttocks when walking; this is called claudication. The pain usually improves after a period of rest. Other symptoms include numbness, weakness or a tingling sensation when attempting to walk. In more severe cases patients can have pain in the legs even while at rest and can develop ulcers of the feet which do not heal. In the most severe cases a person's feet or legs can become cold, pale and numb. This can eventually lead to gangrene which will require amputation of the affected part of the foot and/or leg.
SJRA offers a non-invasive vascular health screen which will evaluate your carotid arteries, abdominal aorta, as well as calculate your ABI's (ankle-brachial indices). This is a quick and painless screening exam which will determine your probability of having peripheral arterial disease. If this study is positive further evaluation of your arterial circulation can be performed with a special type of MRI called "magnetic resonance angiogram" (MRA) or CT scan “CT angiogram”; these studies will show which particular arteries are narrowed or blocked.
Lifestyle changes such as smoking cessation and exercise are usually the first line of defense against PAD. A regular exercise regime is especially helpful in increasing the distance that a person can walk before cramping (claudication) occurs. In addition, new medications have become available recently which may help increase walking distance.
Sometimes symptoms become severe enough that these initial conservative measures are not adequate. In the past, patients often had to undergo surgery to improve blood flow to their legs. The three main types of surgery performed are bypasses, endarterectomy and embolectomy. All of these surgeries require that incisions be made in the operating room. In a bypass a piece of vein or a synthetic tube is used to re-route blood around a blockage or narrowing much like re- routing plumbing. Endarterectomy involves removing diseased arterial segments, and embolectomy removing clot. Surgery can be very effective at relieving or improving the symptoms of PAD. Unfortunately, surgery carries with it significant risks such as infection and bleeding, as well as exposure to general anesthesia. In addition, surgery often requires a stay in the hospital and a prolonged recovery period.
The physicians at South Jersey Radiology Associates are able to open many blocked or narrowed arteries with newer endovascular techniques known as angioplasty and stenting. Angioplasty is performed by inserting a catheter, a thin spaghetti sized tube, with a balloon attached to its tip, into a blood vessel through a small nick in the groin area. Using x-ray guidance, the catheter is pushed forward and guided into the diseased vessel. The balloon is then inflated, causing the plaque which is responsible for the narrowing to crack. Often a stent, a metal mesh tube, is also inserted to keep the artery open. The stent is placed on the balloon so that when the balloon is inflated the stent is pressed against the walls of the blood vessel. When the balloon is deflated the stent remains in place to keep the vessel open.
These procedures do not require general anesthesia and patients can leave the hospital on the same day as the procedure. The recovery period is one day, after which people can return to their usual activities. The risk of having a complication such as serious bleeding, infection or death is much lower than it would be with traditional surgical techniques.
There are many treatments for peripheral arterial disease. For many patients endovascular intervention may be the best treatment. However, there are times when alternative traditional surgical treatments are more appropriate. Our interventional radiologists will work closely with your surgeon in evaluating all your options, as well as evaluating your history prior to any planned procedure.
Please call (856) 489-5163 to schedule a consult with our physicians.
