“Today I’d like to talk about PAD.

What is Peripheral Artery Disease, PAD?

Well actually PAD is an abbreviation.

“P” is for “peripheral” which means the exterior of your circulation from outside of your heart, usually your limbs, more commonly referred to your legs.

“A” is for “arterial”, the arteries carrying blood from your heart to your feet is the main focus of “peripheral arterial.”

And the “D” is for “disease.”

So PAD is an abbreviation or an acronym for “peripheral arterial disease” and more euphemistically used to indicate blockages of arteries from your heart to your feet.

PAD stands for peripheral arterial disease. What is peripheral arterial disease? What does it mean? And what causes it?

Peripheral arterial disease usually implies some type of a blockage of an artery between your heart and carrying the blood flow to your feet.”

“It can be anywhere involving your infra renal abdominal aorta, your arteries in your pelvis called your iliac arteries, your femoral arteries in your legs, or your tibial arteries going down to your feet.

Any blockage of those arteries is stopping the blood flow from your heart to the muscles in your lower extremities.

So if you have PAD, it means that you have blocked arteries with cholesterol and plaque build-up restricting the blood flow to your lower extremity muscles and your feet.

When you have PAD, which is peripheral arterial disease, it is most commonly caused by smoking, diabetes, hypercholesterolemia, hyper tension and hereditary factors, combined with obesity and a sedentary lifestyle.

Once you have a blocked artery going to your lower extremities, what are the usual symptoms?

Well, your body at rest, while you’re sitting still, your legs and your body don’t require much blood flow. There are no real symptoms of PAD when you’re sitting at rest except in very extreme, advanced cases.

But when your muscles require more blood flow, as in when you start to walk or run, climb stairs, or hold packages, then the muscles call on the arteries to increase their blood flow to the muscles to handle the increased load.

Well if you have a blockage, peripheral arterial disease, the blood cannot increase fast enough through that blockage because it causes a restriction.

That restriction causes restriction in the blood flow to the leg, causing your muscle to generate lactic acidosis which causes muscle cramping.”

“So the normal scenario is…my mailbox is at the end of my driveway. As I leave my house I start to walk to my mailbox. At about the halfway point, which may be 50-100 feet, at the exact same distance everyday, my muscle starts to cramp. Well, I stopped walking. That gives your muscles a chance for the blood flow to catch back up and your cramp resolves. You turn around, you walk the exact same distance, you get the exact same cramp, which goes away with rest.

Cramping with exercise, relieved by rest is called claudication. It comes from the Latin word “claudis”, meaning to limp. And is the classic symptom of peripheral arterial disease.

My physician told me I have PAD, peripheral arterial disease. How do I know? How does he know? How do I know for sure?

Well once your physician has determined from your history, your physical examination that you in fact may have a blockage in one of the arteries in your lower extremities (peripheral arterial disease), it’s time to move on to some more definitive objective testing.

So what do we do? At The Vein and Vascular Institute we have the most sophisticated non-invasive vascular technology available in the world.”

“We have board certified vascular surgeons with additional board certifications to interpret the vascular studies. Our vascular laboratory is Nationally Accredited, and our ultrasound technicians are all registered.

What we do at that point is we perform imaging studies of the arteries using duplex imaging which is a way to use ultrasound to actually look inside of your arteries. We can actually visualize the plaque build-up in your arteries and decide if it’s present and if it’s significant or not.

There’s other various testing we use such as blood pressure measurements and pulse recordings that use pulse volume recordings which will also decide on how much blood pressure and blood flow you have in your legs.

So we’re able to combine history, physical examination, with non-invasive testing in our vascular laboratory as an outpatient, covered by insurance, and all virtually painless to come up with a conclusive diagnosis of you having significant peripheral arterial disease or not.

What can we do about that once the history, physical examination and non-invasive testing say I have a blockage in an artery in my leg…what can we do next?

The first thing we do is conservative treatment. We address your risk factors. We strongly urge you to stop smoking, to lose weight, to watch your blood pressure, to watch your blood sugar and to exercise rigorously three times a week. We give you an exercise program designed for that.

If in fact that is not enough to help or address the symptoms and the symptoms either persist or worsen, there are certain medications we can prescribe that do increase blood flow to the lower extremities.

If in fact conservative treatment and certain medications prescribed do not help you and it’s getting to a point where it’s affecting your activities of daily living, what can we do about the blockage at that point? What are our options?

Fortunately, at The Vein and Vascular Institute of Tampa Bay, we have one of the only free-standing vascular surgery endovascular suites attached to our own office where we are able to endovascularly diagnose and treat actual lesions in your legs in our outpatient facility.”

“What that involves is the finest x-ray techniques, endovascular ultrasound techniques and arterial graphic techniques to minimally invasively place a small needle, or a sheath into the artery where we pass an ultrasound, which is called an intravascular venous ultrasound, or arterial ultrasound to diagnose the lesions and find the actual location of the blockage by not only ultrasound but by arteriography where we put some dye down there too.

Once we locate the lesion, and it can be anywhere from your abdomen to your foot, we find the blockage, we have multiple ways of treating it.

Once we find the narrowing, we can put a balloon in it, expand it, called balloon angioplasty. After we balloon it, if that doesn’t treat it, we can open a stent up which holds the vessel open.”

“We also have atherectomy catheters which are basically roto-rooter catheters which clean the artery out. We have extensive stents, wires, technology and balloons to treat almost any lesion in your arteries.

So when you come in with a blockage and a symptom and can’t walk, we can actually fix it through a little needle stick, within less than an hour, you’re back at home within 2 hours completely cured without having to go to the hospital, without having to undergo general anesthesia and without having to undergo an incision whatsoever.

Once you’ve had an intervention for a peripheral arterial lesion in our endovascular suite, it usually involves a small puncture in your artery and the treatment is all taken car of through a small puncture and a sheath. There’s no incisions.

The recovery time here is usually an hour or two. We make sure everything is safe and there’s no bleeding, there’s no swelling, there’s no complications. Once we’ve deemed everything is fine, you go home that day under your own power, you walk, you go home.

We suggest you don’t do any heavy lifting or any strenuous activities over the next few days but you can return to your normal lifestyle the very next day.

I’ve been told I have peripheral arterial disease and I need treatment. I heard that you have your own outpatient endovascular suite and you can actually perform interventions there and cure me at your institution. Is that covered by insurance?

I get a lot of questions about “how can I pay for it?” “Who’s going to cover it?”

Because this is a severe limb and life-threatening medical condition all insurances cover our interventions at our outpatient access center.”